home Adviсe Attention deficit disorder in children, or how to raise a hyperactive child? Symptoms in children of different ages. Early detection of hyperactivity syndrome

Attention deficit disorder in children, or how to raise a hyperactive child? Symptoms in children of different ages. Early detection of hyperactivity syndrome

or ADHD is the most common cause of behavior disorders and learning problems in preschool and school children.

Attention deficit hyperactivity disorder in a child– a developmental disorder manifested in behavioral disturbances. A child with ADHD is restless, displays “stupid” activity, cannot sit through classes at school or kindergarten, and will not do anything that is not interesting to him. He interrupts his elders, plays in class, minds his own business, and can crawl under the desk. At the same time, the child correctly perceives his surroundings. He hears and understands all the instructions of his elders, but cannot follow their instructions due to impulsiveness. Despite the fact that the child understands the task, he cannot complete what he started and is unable to plan and foresee the consequences of his actions. This is associated with a high risk of getting injured at home and getting lost.

Neurologists consider attention deficit hyperactivity disorder in a child as a neurological disease. Its manifestations are not the result of improper upbringing, neglect or permissiveness, they are a consequence of the special functioning of the brain.

Prevalence. ADHD is found in 3-5% of children. Of these, 30% “outgrow” the disease after 14 years, another 40% adapt to it and learn to smooth out its manifestations. Among adults, this syndrome is found in only 1%.

Boys are diagnosed with attention deficit hyperactivity disorder 3-5 times more often than girls. Moreover, in boys the syndrome is more often manifested by destructive behavior (disobedience and aggression), and in girls by inattention. According to some studies, fair-haired and blue-eyed Europeans are more susceptible to the disease. Interestingly, the incidence rate varies significantly from country to country. Thus, studies conducted in London and Tennessee found ADHD in 17% of children.

Types of ADHD

Attention deficit and hyperactivity are expressed equally;
Attention deficit predominates, and impulsivity and hyperactivity are minor;
Hyperactivity and impulsiveness predominate, attention is slightly impaired.

Treatment. The main methods are pedagogical measures and psychological correction. Drug treatment is used in cases where other methods have been ineffective because the drugs used have side effects.
If you leave your child with attention deficit hyperactivity disorder Without treatment, the risk of developing:

dependence on alcohol, drugs, psychotropic drugs;
difficulties with assimilation of information that disrupt the learning process;
high anxiety, which replaces physical activity;
Tics – repeated muscle twitching.
headaches;
antisocial changes - a tendency to hooliganism, theft.

Controversial points. A number of leading experts in the field of medicine and public organizations, including the Citizens Commission on Human Rights, deny the existence of attention deficit hyperactivity disorder in children. From their point of view, manifestations of ADHD are considered a feature of temperament and character, and therefore cannot be treated. They can be a manifestation of the natural mobility and curiosity of an active child, or protest behavior that occurs in response to a traumatic situation - abuse, loneliness, divorce of parents.

Attention deficit hyperactivity disorder in a child, causes

The cause of attention deficit hyperactivity disorder in a child cannot be installed. Scientists are convinced that the disease is provoked by a combination of several factors that disrupt the functioning of the nervous system.

Factors that disrupt the formation of the nervous system in the fetus which can lead to oxygen starvation or hemorrhage in the brain tissue:

environmental pollution, high content of harmful substances in air, water, food;
taking medications by a woman during pregnancy;
exposure to alcohol, drugs, nicotine;
infections suffered by the mother during pregnancy;
Rh factor conflict – immunological incompatibility;
risk of miscarriage ;
fetal asphyxia;
umbilical cord entanglement;
complicated or rapid labor leading to injury to the head or spine of the fetus.

Factors that disrupt brain function in infancy

diseases accompanied by a temperature above 39-40 degrees;
taking certain medications that have a neurotoxic effect;
bronchial asthma, pneumonia;
severe kidney disease;
heart failure, heart disease.

Genetic factors. According to this theory, 80% of cases of attention deficit hyperactivity disorder are associated with disorders in the gene that regulates the release of dopamine and the functioning of dopamine receptors. The result is a disruption in the transmission of bioelectrical impulses between brain cells. Moreover, the disease manifests itself if, in addition to genetic abnormalities, there are unfavorable environmental factors.

Neurologists believe that these factors can cause damage in limited areas of the brain. In this regard, some mental functions (for example, volitional control over impulses and emotions) develop inconsistently, with a delay, which causes manifestations of the disease. This confirms the fact that children with ADHD showed disturbances in metabolic processes and bioelectrical activity in the anterior parts of the frontal lobes of the brain.

Attention deficit hyperactivity disorder in a child, symptoms

A child with ADHD equally exhibits hyperactivity and inattention at home, in kindergarten, and when visiting strangers. There are no situations in which the baby would behave calmly. This differs him from an ordinary active child.

Signs of ADHD at an early age

Attention deficit hyperactivity disorder in a child, symptoms which most clearly manifests itself at 5-12 years of age, can be recognized at an earlier age.

They begin to hold their heads up, sit, crawl, and walk early.
They experience problems falling asleep and sleep less than normal.
If they get tired, do not engage in a calm activity, do not fall asleep on their own, but become hysterical.
Very sensitive to loud sounds, bright lights, strangers, and changes in environment. These factors cause them to cry loudly.
They throw away toys before they even have time to look at them.

Such signs may indicate a tendency towards ADHD, but they are also present in many restless children under 3 years of age.
ADHD also affects the functioning of the body. The child often experiences digestive problems. Diarrhea is the result of excessive stimulation of the intestines by the autonomic nervous system. Allergic reactions and skin rashes appear more often than among peers.

Main symptoms

Attention disorder

R The child has difficulty concentrating on one subject or activity. He does not pay attention to details, unable to distinguish the main from the secondary. The child tries to do all the things at the same time: he colors all the details without completing them, reads the text, skipping over a line. This happens because he does not know how to plan. When doing tasks together, explain: “First we’ll do one thing, then the other.”
The child tries to avoid routine tasks under any pretext., lessons, creativity. This could be a quiet protest when the child runs away and hides, or a hysteria with screaming and tears.
The cyclical nature of attention is pronounced. A preschooler can do one thing for 3-5 minutes, a child of primary school age for up to 10 minutes. Then, over the same period, the nervous system restores the resource. Often at this time it seems that the child does not hear the speech addressed to him. Then the cycle repeats.
Attention can only be concentrated if you are left alone with the child. The child is more attentive and obedient if the room is quiet and there are no irritants, toys, or other people.

Hyperactivity

The child makes a large number of inappropriate movements, most of which he doesn't notice. A distinctive feature of motor activity in ADHD is its aimlessness. This could be spinning the hands and feet, running, jumping, or tapping on the table or floor. The child runs, not walks. Climbing on furniture . Breaks toys.
Talks too loudly and fast. He answers without listening to the question. Shouts out the answer, interrupting the person answering. He speaks in unfinished sentences, jumping from one thought to another. Swallows the endings of words and sentences. Constantly asks again. His statements are often thoughtless, they provoke and offend others.
Facial expressions are very expressive. The face expresses emotions that quickly appear and disappear - anger, surprise, joy. Sometimes he grimaces for no apparent reason.

It has been found that in children with ADHD, physical activity stimulates the brain structures responsible for thinking and self-control. That is, while the child runs, knocks and takes things apart, his brain is improving. New neural connections are established in the cortex, which will further improve the functioning of the nervous system and relieve the child from the manifestations of the disease.

Impulsiveness

Guided solely by his own desires and carries them out immediately. Acts on the first impulse, without thinking through the consequences and without planning. There are no situations for a child in which he must sit still. During classes in kindergarten or at school, he jumps up and runs to the window, into the corridor, makes noise, shouts from his seat. Takes the thing he likes from his peers.
Cannot follow instructions, especially those consisting of several points. The child constantly has new desires (impulses), which prevent him from finishing the job he has started (doing homework, collecting toys).
Unable to wait or endure. He must immediately get or do what he wants. If this does not happen, he makes a scandal, switches to other things, or performs aimless actions. This is clearly noticeable in class or while waiting for your turn.
Mood swings happen every few minutes. The child goes from laughing to crying. Hot temper is especially common in children with ADHD. When angry, the child throws objects, can start a fight or ruin the offender’s things. He will do it right away, without thinking or hatching a plan for revenge.
The child does not feel danger. He can do things that are dangerous to health and life: climb to a height, walk through abandoned buildings, go out on thin ice because he wanted to do it. This property leads to high rates of injury in children with ADHD.

Manifestations of the disease are due to the fact that the nervous system of a child with ADHD is too vulnerable. She is unable to cope with the large amount of information coming from the outside world. Excessive activity and lack of attention is an attempt to protect yourself from the unbearable load on the nervous system.

Additional symptoms

Difficulties in learning with a normal level of intelligence. The child may have difficulty writing and reading. At the same time, he does not perceive individual letters and sounds or does not fully master this skill. The inability to learn arithmetic can be an independent disorder or accompany problems with reading and writing.
Communication disorders. A child with ADHD may be obsessive towards peers and unfamiliar adults. He may be too emotional or even aggressive, which makes it difficult to communicate and establish friendly contacts.
Lag in emotional development. The child behaves excessively capriciously and emotionally. He does not tolerate criticism, failures, and behaves unbalanced and “childish.” A pattern has been established that with ADHD there is a 30% lag in emotional development. For example, a 10-year-old child behaves like a 7-year-old, although he is intellectually developed no worse than his peers.
Negative self-esteem. A child hears a huge number of comments per day. If at the same time he is also compared with his peers: “Look how well Masha behaves!” this makes the situation worse. Criticism and complaints convince the child that he is worse than others, bad, stupid, restless. This makes the child unhappy, distant, aggressive, and instills hatred towards others.

Manifestations of attention deficit disorder are associated with the fact that the child’s nervous system is too vulnerable. She is unable to cope with the large amount of information coming from the outside world. Excessive activity and lack of attention is an attempt to protect yourself from the unbearable load on the nervous system.

Positive qualities of children with ADHD

Active, active;
Easily read the mood of the interlocutor;
Willing to sacrifice themselves for the people they like;
Not vindictive, unable to harbor a grudge;
They are fearless and do not have most childhood fears.

Attention deficit hyperactivity disorder in a child, diagnosis

Diagnosis of attention deficit hyperactivity disorder may include several stages:

Collection of information - interview with the child, conversation with parents, diagnostic questionnaires.
Neuropsychological examination.
Pediatrician consultation.

As a rule, a neurologist or psychiatrist makes a diagnosis based on a conversation with the child, analyzing information from parents, caregivers and teachers.

Collection of information

The specialist receives most of the information during a conversation with the child and observing his behavior. The conversation with children takes place orally. When working with adolescents, the doctor may ask you to fill out a questionnaire that resembles a test. Information received from parents and teachers helps complete the picture.

Diagnostic questionnaire is a list of questions compiled in such a way as to collect the maximum amount of information about the behavior and mental state of the child. It usually takes the form of a multiple-choice test. To identify ADHD, the following are used:

Vanderbilt Adolescent ADHD Diagnostic Questionnaire. There are versions for parents and teachers.
Parental Symptom Questionnaire for ADHD Manifestations;
Conners Structured Questionnaire.

According to the international classification of diseases ICD-10 diagnosis of attention deficit hyperactivity disorder in a child diagnosed when the following symptoms are detected:

Adaptation disorder. Expressed as non-compliance with characteristics that are normal for this age;
Attention impairment, when the child cannot focus his attention on one object;
Impulsivity and hyperactivity;
Development of first symptoms before the age of 7 years;
Adaptation disorder manifests itself in various situations (in kindergarten, school, at home), while the child’s intellectual development corresponds to his age;
These symptoms persist for 6 months or more.

A doctor has the right to make a diagnosis of “attention deficit hyperactivity disorder” if at least 6 symptoms of inattention and at least 6 symptoms of impulsivity and hyperactivity are detected and followed for 6 months or more. These signs appear constantly, not from time to time. They are so pronounced that they interfere with the child’s learning and daily activities.

Signs of inattention

Doesn't pay attention to details. In his work he makes a large number of mistakes due to negligence and frivolity.
Easily distracted.
Has difficulty concentrating when playing and completing tasks.
Does not listen to speech addressed to him.
Unable to complete assignments or do homework. Cannot follow instructions.
Experiences difficulties in performing independent work. Needs guidance and supervision from an adult.
Resists completing tasks that require prolonged mental effort: homework, tasks from a teacher or psychologist. Avoids such work for various reasons and shows dissatisfaction.
Often loses things.
In everyday activities, he shows forgetfulness and absent-mindedness.

Signs of impulsivity and hyperactivity

Makes a large number of unnecessary movements. Cannot sit quietly in a chair. Spins, makes movements, feet, hands, head.
Cannot sit or remain still in situations where this is necessary - in class, at a concert, in transport.
Shows rash motor activity in situations where this is unacceptable. He gets up, runs, spins, takes things without asking, tries to climb somewhere.
Can't play calmly.
Excessively mobile.
Too talkative.
He answers without listening to the end of the question. Doesn't think before giving an answer.
Impatient. Has difficulty waiting his turn.
Disturbs others, pesters people. Interferes with play or conversation.

Strictly speaking, the diagnosis of ADHD is based on the subjective opinion of a specialist and his personal experience. Therefore, if the parents do not agree with the diagnosis, then it makes sense to contact another neurologist or psychiatrist who specializes in this problem.

Neuropsychological assessment for ADHD

In order to study the features of the brain, the child is given electroencephalographic examination (EEG). This is a measurement of the bioelectrical activity of the brain at rest or while performing tasks. To do this, the electrical activity of the brain is measured through the scalp. The procedure is painless and harmless.
For ADHD the beta rhythm is reduced and the theta rhythm is increased. The ratio of theta rhythm and beta rhythm several times higher than normal. This suggests that the bioelectrical activity of the brain is reduced, that is, a smaller number of electrical impulses are generated and transmitted through neurons compared to the norm.

Pediatrician consultation

Manifestations similar to ADHD can be caused by anemia, hyperthyroidism and other somatic diseases. A pediatrician can confirm or exclude them after a blood test for hormones and hemoglobin.
Note! As a rule, in addition to the diagnosis of ADHD, the neurologist indicates a number of diagnoses in the child’s medical record:

Minimal brain dysfunction(MMD) – mild neurological disorders that cause disturbances in motor functions, speech, and behavior;
Increased intracranial pressure(ICP) - increased pressure of the cerebrospinal fluid (CSF), which is located in the ventricles of the brain, around it and in the spinal canal.
Perinatal CNS damage– damage to the nervous system that occurs during pregnancy, childbirth or in the first days of life.

All these disorders have similar manifestations, which is why they are often written together. Such an entry on the card does not mean that the child has a large number of neurological diseases. On the contrary, the changes are minimal and can be corrected.

Attention deficit hyperactivity disorder in a child, treatment

Medication treatment for ADHD

Medications are prescribed according to individual indications only if the child’s behavior cannot be improved without them.

Group of drugs	Representatives	The effect of taking medications
Psychostimulants	Levamphetamine, Dexamphetamine, Dexmethylphenidate	The production of neurotransmitters increases, due to which the bioelectrical activity of the brain is normalized. Improves behavior, reduces impulsivity, aggressiveness, and symptoms of depression.
Antidepressants, norepinephrine reuptake inhibitors	Atomoxetine. Desipramine, Bupropion	Reduce the reuptake of neurotransmitters (dopamine, serotonin). Their accumulation in synapses improves the transmission of signals between brain cells. Increase attention and reduce impulsiveness.
Nootropic drugs	Cerebrolysin, Piracetam, Instenon, Gamma-aminobutyric acid	They improve metabolic processes in brain tissue, its nutrition and oxygen supply, and the absorption of glucose by the brain. Increases the tone of the cerebral cortex. The effectiveness of these drugs has not been proven.
Sympathomimetics	Clonidine, Atomoxetine, Desipramine	Increases cerebral vascular tone, improving blood circulation. Helps normalize intracranial pressure.

Treatment is carried out with low doses of drugs to minimize the risk of side effects and addiction. It has been proven that improvement occurs only while taking the medications. After their withdrawal, symptoms reappear.

Physiotherapy and massage for ADHD

This set of procedures is aimed at treating birth injuries of the head, cervical spine, and relieving neck muscle spasms. This is necessary to normalize cerebral circulation and intracranial pressure. For ADHD the following are used:

Physiotherapy, aimed at strengthening the muscles of the neck and shoulder girdle. Must be performed daily.
Neck massage courses of 10 procedures 2-3 times a year.
Physiotherapy. Infrared irradiation (warming) of spasming muscles is used using infrared rays. Paraffin heating is also used. 15-20 procedures 2 times a year. These procedures go well with massage of the collar area.

Please note that these procedures can only be started after consultation with a neurologist and orthopedist.
You should not resort to the services of chiropractors. Treatment by an unqualified specialist, without prior x-raying of the spine, can cause serious injury.

Attention deficit hyperactivity disorder in a child, behavior correction

Biofeedback therapy (biofeedback method)

Biofeedback therapy– a modern treatment method that normalizes the bioelectrical activity of the brain, eliminating the cause of ADHD. It has been effectively used to treat the syndrome for more than 40 years.

The human brain generates electrical impulses. They are divided depending on the frequency of vibrations per second and the amplitude of vibrations. The main ones are: alpha, beta, gamma, delta and theta waves. In ADHD, the activity of beta waves (beta rhythm), which are associated with focusing attention, memory, and information processing, is reduced. At the same time, the activity of theta waves (theta rhythm) increases, which indicate emotional stress, fatigue, aggressiveness and imbalance. There is a version that the theta rhythm promotes the rapid assimilation of information and the development of creative potential.

The goal of biofeedback therapy is to normalize the bioelectrical oscillations of the brain - to stimulate the beta rhythm and reduce the theta rhythm to normal. For this purpose, a specially developed software and hardware complex “BOS-LAB” is used.
Sensors are attached to certain places on the child's body. On the monitor, the child sees how his biorhythms behave and tries to change them at will. Also, biorhythms change during computer exercises. If the task is done correctly, a sound signal is heard or a picture appears, which are an element of feedback. The procedure is painless, interesting and well tolerated by the child.
The effect of the procedure is increased attention, decreased impulsivity and hyperactivity. Academic performance and relationships with others improve.

The course consists of 15-25 sessions. Progress is noticeable after 3-4 procedures. The effectiveness of treatment reaches 95%. The effect lasts for a long time, for 10 years or more. In some patients, biofeedback therapy completely eliminates the manifestations of the disease. Has no side effects.

Psychotherapeutic techniques

The effectiveness of psychotherapy is significant, but progress may take from 2 months to several years. The result can be improved by combining various psychotherapeutic techniques, pedagogical measures of parents and teachers, physiotherapeutic methods and adherence to a daily routine.

Cognitive-behavioral methods

The child, under the guidance of a psychologist, and then independently, forms various behavior patterns. In the future, the most constructive, “correct” ones are selected from them. At the same time, the psychologist helps the child understand his inner world, emotions and desires.
Classes are conducted in the form of a conversation or a game, where the child is offered various roles - a student, a buyer, a friend or an opponent in a dispute with peers. Children act out the situation. Then the child is asked to determine how each participant feels. Did he do the right thing?

Skills in managing anger and expressing your emotions in an acceptable manner. What do you feel? What do you want? Now say it politely. What we can do?
Constructive conflict resolution. The child is taught to negotiate, look for compromise, avoid quarrels or get out of them in a civilized manner. (If you don’t want to share, offer another toy. If you are not accepted into the game, come up with an interesting activity and offer it to others). It is important to teach a child to speak calmly, listen to the interlocutor, and clearly formulate what he wants.
Adequate ways of communicating with the teacher and with peers. As a rule, the child knows the rules of behavior, but does not comply with them due to impulsiveness. Under the guidance of a psychologist, the child improves communication skills through play.
Correct methods of behavior in public places - in kindergarten, in class, in a store, at a doctor’s appointment, etc. are mastered in the form of “theater”.

The effectiveness of the method is significant. The result appears after 2-4 months.

Play therapy

In the form of a game that is pleasant for the child, perseverance and attentiveness are formed, learning to control hyperactivity and increased emotionality.
The psychologist individually selects a set of games taking into account the symptoms of ADHD. At the same time, he can change their rules if it is too easy or difficult for the child.
At first, play therapy is carried out individually, then it can become group or family. Games can also be “homework”, or given by the teacher during a five-minute lesson.

Games to develop attention. Find 5 differences in the picture. Identify the smell. Identify the object by touch with your eyes closed. Broken phone.
Games to develop perseverance and combat disinhibition. Hide and seek. Silent. Sort items by color/size/shape.
Games to control motor activity. Throwing the ball at a given pace, which gradually increases. Siamese twins, when children in a pair, hugging each other around the waist, must perform tasks - clap their hands, run.
Games to relieve muscle tension and emotional tension. Aimed at the physical and emotional relaxation of the child. “Humpty Dumpty” for alternate relaxation of different muscle groups.
Games to develop memory and overcome impulsiveness."Speak!" - the presenter asks simple questions. But he can answer them only after the command “Speak!”, before which he pauses for a few seconds.
Computer games, which simultaneously develop perseverance, attention and restraint.

Art therapy

Practicing various types of art reduces fatigue and anxiety, relieves negative emotions, improves adaptation, allows you to realize talents and raise a child’s self-esteem. Helps develop internal control and perseverance, improves the relationship between the child and the parent or psychologist.

By interpreting the results of a child’s work, the psychologist gets an idea of his inner world, mental conflicts and problems.

Drawing colored pencils, finger paints or watercolors. Sheets of paper of different sizes are used. The child can choose the subject of the drawing himself or the psychologist can suggest a topic - “At school”, “My family”.
Sand therapy. You need a sandbox with clean, moistened sand and a set of various molds, including human figures, vehicles, houses, etc. The child decides for himself what exactly he wants to reproduce. Often he plays out plots that unconsciously bother him, but he cannot convey this to adults.
Modeling from clay or plasticine. The child makes figures from plasticine on a given topic - funny animals, my friend, my pet. Activities promote the development of fine motor skills and brain functions.
Listening to music and playing musical instruments. Rhythmic dance music is recommended for girls, and marching music for boys. Music relieves emotional stress, increases perseverance and attention.

The effectiveness of art therapy is average. It is an auxiliary method. Can be used to establish contact with a child or for relaxation.

Family therapy and work with teachers.

A psychologist informs adults about the developmental characteristics of a child with ADHD. Talks about effective methods of work, forms of influence on a child, how to create a system of rewards and sanctions, how to convey to the child the need to fulfill responsibilities and observe prohibitions. This allows you to reduce the number of conflicts and make training and education easier for all participants.
When working with a child, a psychologist draws up a psychocorrection program designed for several months. In the first sessions, he establishes contact with the child and conducts diagnostics to determine the extent of inattention, impulsiveness and aggressiveness. Taking into account individual characteristics, he draws up a correction program, gradually introducing various psychotherapeutic techniques and complicating the tasks. Therefore, parents should not expect drastic changes after the first meetings.

Pedagogical measures

Parents and teachers need to consider the cyclical nature of the brain in children with ADHD. On average, a child takes 7-10 minutes to absorb information, then the brain needs 3-7 minutes to recover and rest. This feature must be used in the learning process, doing homework and in any other activity. For example, give your child tasks that he can complete in 5-7 minutes.

Proper parenting is the main way to combat the symptoms of ADHD. Whether the child will “outgrow” this problem and how successful he or she will be in adulthood depends on the behavior of the parents.

Remember, just because your child has been diagnosed with attention deficit hyperactivity disorder, this does not mean that he is behind his peers in intellectual development. The diagnosis only indicates a borderline state between normality and deviation. Parents will have to put in more effort, show a lot of patience in their upbringing, and in most cases, after 14 years of age, the child will “outgrow” this condition.

Children with ADHD often have high IQ levels and are called “indigo children.” If a child becomes interested in something specific during adolescence, he will direct all his energy to it and bring it to perfection. If this hobby develops into a profession, then success is guaranteed. This is proven by the fact that most major businessmen and prominent scientists suffered from attention deficit hyperactivity disorder in childhood.

January 19

Attention deficit hyperactivity disorder (ADHD), similar to ICD-10 hyperkinetic disorder), is an emerging neuropsychiatric disorder in which there are significant problems with executive functions (eg, attentional control and inhibitory control) that cause attention deficit hyperactivity or impulsivity that is inappropriate for the person's age. These symptoms may begin between the ages of six and twelve years and last more than six months from diagnosis. In school-aged subjects, symptoms of inattention often lead to poor school performance. Although this is a disadvantage, particularly in modern society, many children with ADHD have good attention span for tasks that they find interesting. Although ADHD is the most widely studied and diagnosed psychiatric disorder in children and adolescents, the cause is unknown in most cases.

The syndrome affects 6-7% of children when diagnosed using the criteria of the manual for the diagnosis and statistical recording of mental illnesses, IV revision and 1-2% when diagnosed using the criteria. Whether the prevalence is similar among countries depends largely on how the syndrome is diagnosed. Boys are approximately three times more likely to be diagnosed with ADHD than girls. About 30-50% of people diagnosed in childhood have symptoms in adulthood, and approximately 2-5% of adults have the condition. The condition is difficult to distinguish from other disorders, as well as from the state of normal increased activity. Managing ADHD usually involves a combination of psychological counseling, lifestyle changes, and medications. Drugs are recommended exclusively as first-line treatment in children who exhibit severe symptoms and may be considered for children with mild symptoms who refuse or do not respond to psychological counseling.

Stimulant drug therapy is not recommended for preschool children. Treatment with stimulants is effective for up to 14 months; however, their long-term effectiveness is unclear. Adolescents and adults tend to develop coping skills that apply to some or all of their impairments. ADHD and its diagnosis and treatment have remained controversial since the 1970s. Controversies include medical practitioners, teachers, politicians, parents and the media. Topics include the cause of ADHD and the use of stimulant medications in its treatment. ADHD is recognized by most medical professionals as a congenital disorder, and debate within the medical community largely centers on how it should be diagnosed and treated.

Signs and symptoms

ADHD is characterized by inattention, hyperactivity (an agitated state in adults), aggressive behavior and impulsivity. Learning difficulties and relationship problems are common. Symptoms can be difficult to identify because it is difficult to draw the line between normal levels of inattention, hyperactivity, and impulsivity and significant levels that require intervention. DSM-5-diagnosed symptoms must have been present in a variety of environments for six months or more, and to a degree that is significantly greater than that observed in other subjects of the same age. They can also cause problems in a person's social, academic and professional life. Based on the symptoms present, ADHD can be divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and mixed.

A subject with inattention may have some or all of the following symptoms:

Easily distracted, misses details, forgets things, and frequently switches from one activity to another

Finds it difficult to stay focused on a task

The task becomes boring after just a few minutes if the subject is not doing something enjoyable

Difficulty focusing on organizing and completing tasks or learning something new

Has trouble completing or turning in homework, often losing things (eg, pencils, toys, assignments) needed to complete a task or activity

Doesn't listen when talking

Has his head in the clouds, gets confused easily and moves slowly

Has difficulty processing information as quickly and accurately as others

Has difficulty following instructions

A subject with hyperactivity may have some or all of the following symptoms:

Restlessness or fidgeting in place

Talks nonstop

Rushes towards, touches and plays with everything in sight

Has difficulty sitting during lunch, in class, doing homework, and while reading

Constantly on the move

Has difficulty completing quiet tasks and tasks

These symptoms of hyperactivity tend to disappear with age and develop into “internal restlessness” in adolescents and adults with ADHD.

A subject with impulsivity may have all or more of the following symptoms:

Be quite impatient

Saying inappropriate comments, expressing emotions without restraint, and acting without thinking about the consequences

Has difficulty looking forward to things he wants or looking forward to returning to play

Frequently interrupts the communication or activities of others

People with ADHD are more likely to have difficulty with communication skills such as social interaction and education, as well as maintaining friendships. This is typical for all subtypes. About half of children and adolescents with ADHD exhibit social withdrawal, compared with 10-15% of non-ADHD children and adolescents. People with ADHD have an attention deficit that causes difficulty understanding verbal and nonverbal language, which negatively affects social interaction. They may also fall asleep during interactions and lose social stimulation. Difficulty managing anger is more common in children with ADHD, as are poor handwriting and delayed speech, language and motor development. Although this is a significant disadvantage, particularly in modern society, many children with ADHD have good attention span for tasks that they find interesting.

Related disorders

Children with ADHD have other disorders in about ⅔ of cases. Some commonly occurring disorders include:

There is a link with persistent bedwetting, slow speech and dyspraxia (DCD), with around half of people with dyspraxia having ADHD. Slow speech in people with ADHD may include problems with auditory perception problems such as poor short-term auditory memory, difficulty following instructions, slow processing speed of written and spoken language, difficulty listening in distracting environments such as the classroom, and difficulty understanding read.

Causes

The cause of most cases of ADHD is unknown; however, environmental involvement is suspected. Certain cases are associated with a previous infection or brain injury.

Genetics

See also: The Hunter and Farmer Theory Twin studies indicate that the disorder is often inherited from one of the parents, with genetics accounting for about 75% of cases. Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the syndrome. Genetic factors are thought to be relevant to whether ADHD persists into adulthood. Typically, multiple genes are involved, many of which directly affect dopamine neurotransmission. Genes implicated in dopamine neurotransmission include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2 and BDNF. A common gene variant called LPHN3 is estimated to be responsible for about 9% of cases and, when the gene is present, people respond partially to the stimulant drug. Because ADHD is widespread, natural selection is likely to favor traits, at least in isolation, that may provide a survival advantage. For example, some women may be more attractive to risk-taking men by increasing the frequency of genes that predispose to ADHD in the gene pool.

Because the syndrome is most common in children of anxious or stressed mothers, some theorize that ADHD is a coping mechanism that helps children cope with stressful or dangerous environments, such as increased impulsivity and exploratory behavior. Hyperactivity may be beneficial from an evolutionary perspective in situations involving risk, competition, or unpredictable behavior (such as exploring new places or searching for new food sources). In these situations, ADHD can be beneficial to society as a whole, even if it is harmful to the subject himself. Additionally, in certain environments, it can provide advantages to the subjects themselves, such as quick reactions to predators or outstanding hunting skills.

Environment

Environmental factors presumably play a lesser role. Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorder, which may include symptoms similar to ADHD. Exposure to tobacco smoke during pregnancy can cause problems with the development of the central nervous system and increase the risk of ADHD. Many children exposed to tobacco smoke do not develop ADHD or have only mild symptoms that do not reach the threshold for diagnosis. A combination of genetic predisposition and exposure to tobacco smoke may explain why some children exposed during pregnancy may develop ADHD while others do not. Children exposed to lead, even at low levels, or PCBs may develop problems resembling ADHD and leading to the diagnosis. Exposure to the organophosphorus insecticides chlorpyrifos and dialkyl phosphate has been associated with increased risk; however, the evidence is not conclusive.

Very low birth weight, preterm birth and early exposure also increase risk, as do infections during pregnancy, birth and early childhood. These infections include, but are not limited to, various viruses (fenosis, varicella, rubella, enterovirus 71) and streptococcal bacterial infection. At least 30% of children with traumatic brain injury later develop ADHD, and about 5% of cases are associated with brain damage. Some children may react negatively to food colorings or preservatives. It is possible that certain colored foods may act as a trigger in those with a genetic predisposition, but the evidence is weak. The UK and the European Union have introduced regulation based on these problems; The FDA did not do this.

Society

A diagnosis of ADHD may indicate family dysfunction or a poor educational system rather than an individual problem. Some cases may be due to increased educational expectations, with the diagnosis in some cases representing a way for parents to obtain additional financial and educational support for their children. The youngest children in the class are more likely to be diagnosed with ADHD, which is believed to be due to the fact that they are developmentally behind their older classmates. Behaviors typical of ADHD are more often observed in children who have experienced cruelty and moral humiliation. According to social order theory, societies define the boundary between normal and unacceptable behavior. Members of society, including doctors, parents and teachers, determine which diagnostic criteria to use and thus the number of people affected by the syndrome. This has led to the present situation where the DSM-IV shows a level of ADHD that is three to four times higher than the ICD-10 level. Thomas Szasz, who supports this theory, argued that ADHD was “invented, not discovered.”

Pathophysiology

Current models of ADHD suggest that it is associated with functional impairments in several brain neurotransmitter systems, particularly those involving dopamine and norepinephrine. Dopamine and norepinephrine pathways, which originate in the ventral tegmental area and locus coeruleus, are directed to various regions of the brain and determine many cognitive processes. Dopamine and norepinephrine pathways, which are directed to the prefrontal cortex and striatum (particularly the reward center), are directly responsible for regulating executive function (cognitive control of behavior), motivation and perception of reward; These pathways play a major role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed.

Brain structure

Children with ADHD show an overall decrease in the volume of certain brain structures, with a proportionately greater decrease in the volume of the left prefrontal cortex. The posterior parietal cortex also shows thinning in subjects with ADHD compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits also differ between people with and without ADHD.

Neurotransmitter pathways

It was previously thought that the increased number of dopamine transporters in people with ADHD was part of the pathophysiology, but the increased number has emerged as an adaptation to the effects of stimulants. Current models include the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. Psychostimulants for ADHD provide effective treatment because they increase the activity of neurotransmitters in these systems. Additionally, pathological abnormalities in serotonergic and cholinergic pathways may be observed. Also relevant is the neurotransmission of glutamate, a cotransmitter of dopamine in the mesolimbic pathway.

Executive function and motivation

ADHD symptoms include problems with executive function. Executive function refers to several mental processes that are required to regulate, control, and manage the tasks of daily life. Some of these impairments include problems with organization, time management, excessive procrastination, concentration, speed of execution, emotion regulation, and use of short-term memory. People usually have good long-term memory. 30-50% of children and adolescents with ADHD meet criteria for executive function deficits. One study found that 80% of subjects with ADHD were impaired on at least one executive function task, compared with 50% of subjects without ADHD. Due to the degree of brain maturation and increased demands on executive control as people get older, ADHD disorders may not fully manifest themselves until adolescence or even late teens. ADHD is also associated with motivational deficits in children. Children with ADHD have difficulty focusing on long-term versus short-term rewards and also exhibit impulsive behavior towards short-term rewards. In these subjects, a large amount of positive reinforcement effectively increases performance. ADHD stimulants may increase resilience in children with ADHD equally.

Diagnostics

ADHD is diagnosed by assessing a person's childhood behavior and mental development, including ruling out exposure to drugs, medications, and other medical or psychiatric problems as explanations for symptoms. Feedback from parents and teachers is often taken into account, with most diagnoses made after a teacher raises concerns about the issue. It may be seen as an extreme manifestation of one or more permanent human traits found in all humans. The fact that someone responds to medications does not confirm or rule out the diagnosis. Because brain imaging studies did not provide reliable results across subjects, they were used only for research purposes and not for diagnosis.

DSM-IV or DSM-5 criteria are often used for diagnosis in North America, while European countries usually use ICD-10. Moreover, the DSM-IV criteria are 3-4 times more likely to give a diagnosis of ADHD than the ICD-10 criteria. The syndrome is classified as a neurodevelopmental psychiatric disorder. It is also classified as a social conduct disorder along with oppositional defiant disorder, conduct disorder, and antisocial personality disorder. The diagnosis does not imply a neurological disorder. Associated conditions that should be assessed include anxiety, depression, oppositional defiant disorder, conduct disorder, and learning and speech disorders. Other conditions to consider are other neurodevelopmental disorders, tics, and sleep apnea. Diagnosis of ADHD using quantitative electroencephalography (QEEG) is an area of ongoing research, although the value of QEEG in ADHD is unclear to date. In the United States, the Food and Drug Administration has approved the use of QEEG to estimate the prevalence of ADHD.

Diagnostics and statistical guidance

As with other psychiatric disorders, a formal diagnosis is made by a qualified professional based on a set of several criteria. In the United States, these criteria are defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders. Based on these criteria, three subtypes of ADHD can be distinguished:

ADHD Predominantly Inattentive Type (ADHD-PI) presents with symptoms including being easily distractible, forgetfulness, daydreaming, disorganization, poor concentration, and difficulty completing tasks. Often people refer to ADHD-PI as “attention deficit disorder” (ADD), however, the latter has not been officially approved since the 1994 revision of the DSM.

ADHD, predominantly of the hyperactive-impulsive type, manifests itself as excessive restlessness and agitation, hyperactivity, difficulty waiting, difficulty staying still, and infantile behavior; Disruptive behavior may also occur.

Mixed ADHD is a combination of the first two subtypes.

This classification is based on the presence of at least six of nine long-term (lasting at least six months) symptoms of inattention, hyperactivity-impulsivity, or both. To be taken into account, symptoms must begin between the ages of six and twelve years and be observed in more than one surrounding location (for example, at home and at school or work). The symptoms must not be acceptable for children of this age, and there must be evidence that they are causing problems related to school or work. Most children with ADHD have a mixed type. Children with the inattentive subtype are less likely to pretend or have difficulty getting along with other children. They may sit quietly, but not paying attention, and as a result, difficulties may be overlooked.

International Classification of Diseases

In ICD-10, the symptoms of “hyperkinetic disorder” are similar to ADHD in DSM-5. When a conduct disorder (as defined by ICD-10) is presented, the condition is referred to as hyperkinetic conduct disorder. Otherwise, the disorder is classified as activity and attention disorder, other hyperkinetic disorder, or unspecified hyperkinetic disorder. The latter are sometimes referred to as hyperkinetic syndrome.

Adults

Adults with ADHD are diagnosed according to the same criteria, including symptoms that may be present between the ages of six and twelve. Interviewing parents or guardians about how the person behaved and developed as a child may form part of the assessment; a family history of ADHD also contributes to diagnosis. While the core symptoms of ADHD are the same in children and adults, they often present differently; for example, excessive physical activity seen in children may manifest as feelings of restlessness and constant mental alertness in adults.

Differential diagnosis

ADHD symptoms that may be associated with other disorders

Depression:

Feelings of guilt, hopelessness, low self-esteem, or unhappiness

Loss of interest in hobbies, routine activities, sex or work

Fatigue

Too little, poor or excessive sleep

Changes in appetite

Irritability

Low stress tolerance

Suicidal thoughts

Unexplained pain

Anxiety disorder:

Restlessness or persistent feeling of anxiety

Irritability

Inability to relax

Overexcitement

Easy fatigue

Low stress tolerance

Difficulty paying attention

Mania:

Excessive feeling of happiness

Hyperactivity

A race of ideas

Aggression

Excessive talkativeness

Grandiose delusional ideas

Decreased need for sleep

Inappropriate social behavior

Difficulty paying attention

ADHD symptoms such as low mood and low self-esteem, mood swings and irritability can be confused with dysthymia, cyclothymia or bipolar disorder, as well as borderline personality disorder. Some symptoms that are associated with anxiety disorders, antisocial personality disorder, developmental or intellectual disabilities, or chemical dependency effects such as intoxication and withdrawal may overlap with some symptoms of ADHD. These disorders sometimes occur along with ADHD. Medical conditions that can cause ADHD symptoms include: hypothyroidism, epilepsy, lead toxicity, hearing deficits, liver disease, sleep apnea, drug interactions, and traumatic brain injury. Primary sleep disorders can affect attention and behavior, and ADHD symptoms can affect sleep. Therefore, it is recommended that children with ADHD be screened regularly for sleep problems. Sleepiness in children can lead to symptoms ranging from classic yawning and eye rubbing to hyperactivity with inattention. Obstructive sleep apnea can also cause ADHD-type symptoms.

Control

Management of ADHD usually involves psychological counseling and medications, alone or in combination. While treatment may improve long-term outcomes, it does not eliminate negative outcomes overall. Drugs used include stimulants, atomoxetine, alpha-2 adrenergic agonists, and sometimes antidepressants. Dietary changes may also be beneficial, with evidence supporting free fatty acids and reduced exposure to food dyes. Removing other foods from the diet is not supported by evidence.

Behavioral therapy

There is good evidence for the use of behavioral therapy for ADHD, and it is recommended as first-line treatment for those with mild symptoms or for preschool-aged children. Physiological therapies used include: psychoeducational stimulation, behavioral therapy, cognitive behavioral therapy (CBT), interpersonal therapy, family therapy, school interventions, social skills training, parent training, and neural feedback. Parent training and education have short-term benefits. There is little high-quality research into the effectiveness of family therapy for ADHD, but evidence suggests that it is equivalent to social care and better than placebo. There are some ADHD-specific support groups as information resources that can help families cope with ADHD.

Social skills training, behavioral modification, and medications may have some limited benefit. The most important factor in alleviating later psychological problems such as major depression, delinquency, school failure, and substance use disorder is forming friendships with people who are not involved in delinquent activities. Regular physical activity, particularly aerobic exercise, is an effective adjunct to the treatment of ADHD, although the best type and intensity is currently unknown. In particular, physical activity causes better behavior and motor abilities without any side effects.

Medications

Stimulant medications are the pharmaceutical treatment of choice. They have at least short-term effects in about 80% of people. There are several non-stimulant medications, such as atomoxetine, bupropion, guanfacine, and clonidine, that can be used as alternatives. There are no good studies comparing different drugs; however, they are more or less equal in terms of side effects. Stimulants improve academic performance, while atomoxetine does not. There is little evidence regarding its effect on social behavior. Medicines are not recommended for preschool children, as long-term effects in this age group are not known. The long-term effects of stimulants are generally unclear, with only one study finding beneficial effects, another finding no benefit, and a third finding harmful effects. Magnetic resonance imaging studies suggest that long-term treatment with amphetamine or methylphenidate reduces the pathological abnormalities in brain structure and function found in subjects with ADHD.

Atomoxetine, due to its lack of addictive potential, may be preferable for those at risk of addiction to a stimulant drug. Recommendations about when to use drugs vary between countries, with the UK's National Institute for Health and Care Excellence recommending their use only in severe cases, while American guidelines recommend using drugs in almost all cases. While atomoxetine and stimulants are generally safe, there are side effects and contraindications for their use.

Stimulants can cause psychosis or mania; however, this is a relatively rare occurrence. For those undergoing long-term treatment, regular screening is recommended. Stimulant therapy should be discontinued temporarily to assess subsequent drug requirements. Stimulant drugs have the potential to develop addiction and dependence; Several studies suggest that untreated ADHD is associated with an increased risk of chemical dependency and conduct disorder. The use of stimulants either reduces this risk or has no effect on it. The safety of these drugs during pregnancy has not been determined.

Zinc deficiency has been linked to symptoms of inattention, and there is evidence that zinc supplementation is beneficial for children with ADHD who have low zinc levels. Iron, magnesium and iodine may also have an effect on ADHD symptoms.

Forecast

An 8-year study of children diagnosed with ADHD (mixed) found that difficulties with adolescents were common, regardless of treatment or lack thereof. In the United States, less than 5% of subjects with ADHD obtain a college degree, compared with 28% of the general population aged 25 or older. The proportion of children meeting criteria for ADHD drops to about half within three years of diagnosis, regardless of treatment. ADHD persists into adults in approximately 30-50% of cases. Those suffering from the syndrome are likely to develop coping mechanisms as they get older, thus compensating for previous symptoms.

Epidemiology

It is estimated that ADHD affects about 6-7% of people aged 18 years and older when diagnosed using DSM-IV criteria. When diagnosed using ICD-10 criteria, the prevalence in this age group is estimated to be 1-2%. North American children have a higher prevalence of ADHD than African and Middle Eastern children; this is presumably due to differing diagnostic methods rather than differences in the incidence of the syndrome. If the same diagnostic methods were used, the prevalence would be more or less the same in different countries. The diagnosis is made approximately three times more often in boys than girls. This difference between the sexes may reflect either a difference in susceptibility or that girls with ADHD are less likely to be diagnosed with ADHD than boys. The intensity of diagnosis and treatment has increased in both the UK and the US since the 1970s. This is thought to be due primarily to changes in the diagnosis of the disease and how willing people are to seek drug treatment, rather than to changes in the prevalence of the disease. Changes in diagnostic criteria in 2013 with the release of DSM-5 are thought to have increased the percentage of people diagnosed with ADHD, especially among adults.

Story

Hyperactivity has long been part of human nature. Sir Alexander Crichton describes "mental agitation" in his book An Inquiry into the Nature and Origin of Mental Disorder, written in 1798. ADHD was first clearly described by George Still in 1902. The terminology used to describe the condition has changed over time and includes: in the DSM -I (1952) "minimal brain dysfunction", in DSM-II (1968) "hyperkinetic childhood reaction", in DSM-III (1980) "attention deficit disorder (ADD) with or without hyperactivity" . It was renamed ADHD in DSM-III-R in 1987, and DSM-IV in 1994 reduced the diagnosis to three subtypes, ADHD inattentive type, ADHD hyperactive-impulsive type, and ADHD mixed type. These concepts were retained in the DSM-5 in 2013. Other concepts included “minimal brain injury,” which was used in the 1930s. The use of stimulants to treat ADHD was first described in 1937. In 1934, Benzedrine became the first amphetamine drug approved for use in the United States. Methylphenidate was discovered in the 1950s and enantiopure dextroamphetamine in the 1970s.

Society and culture

Controversy

ADHD and its diagnosis and treatment have been subject to debate since the 1970s. The controversy involves doctors, teachers, politicians, parents and the media. Opinions regarding ADHD range from the fact that it merely represents the extreme limit of normal behavior to the fact that it is the result of a genetic condition. Other areas of controversy include the use of stimulant medications and especially their use in children, as well as the method of diagnosis and the potential for overdiagnosis. In 2012, the UK's National Institute for Health and Care Excellence, while acknowledging the controversy, stated that current treatments and diagnostic methods are based on the prevailing view of the academic literature.

In 2014, Keith Conners, one of the first advocates for disease confirmation, spoke out against overdiagnosis in an op-ed in the NY Times. On the contrary, in 2014, a peer-reviewed review of the medical literature found that ADHD is rarely diagnosed in adults. Due to widely varying diagnostic rates among countries, states within countries, and races and ethnic groups, several questionable factors other than the presence of ADHD symptoms play a role in diagnosis. Some sociologists believe that ADHD represents an example of the medicalization of “deviant behavior” or, in other words, the transformation of a previously unrelated problem of school performance into one. Most health care providers recognize ADHD as a congenital disorder in at least a small number of people with severe symptoms. The debate among medical professionals largely focuses on diagnosing and treating the larger population of people with less severe symptoms.

In 2009, 8% of all US Major League Baseball players were diagnosed with ADHD, making the syndrome widespread among this population. The increase coincides with the League's 2006 ban on stimulants, raising concerns that some players were faking or falsifying symptoms of ADHD to circumvent the sport's ban on stimulants.

MINISTRY OF EDUCATION OF THE RUSSIAN FEDERATION

BARNAUL STATE PEDAGOGICAL UNIVERSITY

FACULTY OF PEDAGOGY

COURSE WORK

"PECULIARITIES OF MENTAL DEVELOPMENT OF CHILDREN WITH ATTENTION DEFICIT SYNDROME AND HYPERACTIVITY"

Barnaul – 2008

Plan

Introduction

1. Hyperactivity and attention deficit disorder in childhood

1.1 Theoretical basis for the concept of ADHD

1.2 The concept of hyperactivity disorder and attention deficit disorder

1.3 Views and theories of domestic and foreign psychologists in ADHD research

2. Etiology, mechanisms of development of ADHD. Clinical signs of ADHD. Psychological characteristics of children with ADHD. Treatment and correction of ADHD

2.1 Etiology of ADHD

2.2 Mechanisms of development of ADHD

2.3 Clinical features of ADHD

2.4 Psychological characteristics of children with ADHD

2.5 Treatment and correction of ADHD

3. Experimental study of mental processes in children with ADHD and with normal development

3.1 Attention research

3.2 Study of thinking

3.3 Memory research

3.4 Perception research

3.5 Study of emotional manifestations

Conclusion

Bibliography

Applications

Introduction

The need to study children with attention deficit hyperactivity disorder (ADHD) in preschool age is due to the fact that this syndrome is one of the most common reasons for seeking psychological help in childhood.

The most complete definition of hyperactivity is given by G.N. Monina. in his book on working with children suffering from attention deficit: “A complex of deviations in child development: inattention, distractibility, impulsiveness in social behavior and intellectual activity, increased activity with a normal level of intellectual development. The first signs of hyperactivity may be observed before the age of 7 years. The causes of hyperactivity may be organic lesions of the central nervous system (neuroinfections, intoxication, traumatic brain injury), genetic factors leading to dysfunction of the neurotransmitter systems of the brain and disturbances in the regulation of active attention and inhibitory control.”

According to various authors, hyperactive behavior occurs quite often: from 2 to 20% of students are characterized by excessive mobility and disinhibition. Among children with conduct disorder, doctors identify a special group of children suffering from minor functional disorders of the central nervous system. These children are not much different from healthy ones, except for their increased activity. However, gradually deviations of individual mental functions increase, which leads to pathology, which is most often called “mild brain dysfunction.” There are other designations: “hyperkinetic syndrome”, “motor disinhibition” and so on. A disease characterized by these indicators is called “attention deficit hyperactivity disorder” (ADHD). And the most important thing is not that a hyperactive child creates problems for surrounding children and adults, but the possible consequences of this disease for the child himself. Two features of ADHD should be emphasized. Firstly, it manifests itself most clearly in children aged 6 to 12 years and, secondly, it occurs 7–9 times more often in boys than in girls.

In addition to mild brain dysfunction and minimal brain dysfunction, some researchers (I.P. Bryazgunov, E.V. Kasatikova, A.D. Kosheleva, L.S. Alekseeva) also call the causes of hyperactive behavior also features of temperament, as well as defects in family upbringing . Interest in this problem does not decrease, because if 8–10 years ago there were one or two such children in a class, now there are up to five or more. I.P. Bryazgunov notes that if at the end of the 50s there were about 30 publications on this topic, then in 1990 their number increased to 7000.

Long-term manifestations of inattention, impulsiveness and hyperactivity, the leading signs of ADHD, often lead to the formation of deviant forms of behavior (Kondrashenko V.T., 1988; Egorova M.S., 1995; Kovalev V.V., 1995; Gorkovaya I.A., 1994; Grigorenko E.L., 1996; Zakharov A.I., 1986, 1998; Fischer M., 1993). Cognitive and behavioral disorders continue to persist in almost 70% of adolescents and more than 50% of adults who were diagnosed with ADHD in childhood (Zavadenko N.N., 2000). In adolescence, hyperactive children early develop a craving for alcohol and drugs, which contributes to the development of delinquent behavior (Bryazgunov I.P., Kasatikova E.V., 2001). They, to a greater extent than their peers, are characterized by a tendency to commit crimes (Mendelevich V.D., 1998).

Attention is also drawn to the fact that attention deficit hyperactivity disorder is given the main attention only when a child enters school, when school maladjustment and poor performance are evident (Zavadenko N.N., Uspenskaya T.Yu., 1994; Kuchma V.R. , Platonova A.G., 1997; Razumnikova O.M., Golosheikin S.A., 1997; Kasatikova E.B., Bryazgunov I.P., 2001).

The study of children with this syndrome and the development of deficit functions is of great importance for psychological and pedagogical practice in preschool age. Early diagnosis and correction should be focused on preschool age (5 years), when the compensatory capabilities of the brain are great, and it is still possible to prevent the formation of persistent pathological manifestations (Osipenko T.N., 1996; Litsev A.E., 1995; Khaletskaya O. IN 1999) .

Modern directions of developmental and correctional work (Semenovich A.V., 2002; Pylaeva N.M., Akhutina T.V., 1997; Obukhov Ya.L., 1998; Semago N.Ya., 2000; Sirotyuk A.L. , 2002) are based on the principle of replacement development. There are no programs that consider the multimorbidity of developmental problems of a child with ADHD in combination with problems in the family, peer group and adults accompanying the child’s development, based on a multimodal approach.

An analysis of the literature on this issue showed that in most studies, observations were carried out on school-age children, i.e. during the period when the signs appear most clearly, and the conditions of development in early and preschool age remain, basically, outside the field of view of the psychological service. Right now, the problem of early detection of attention deficit hyperactivity disorder, prevention of risk factors, its medical, psychological and pedagogical correction, covering multimorbidity of problems in children, is becoming increasingly important, which makes it possible to make a favorable prognosis for treatment and organize corrective action.

In this work, an experimental study was conducted, the purpose of which was to study the characteristics of the cognitive development of children with attention deficit hyperactivity disorder.

Object of study is the cognitive development of children with attention deficit hyperactivity disorder in preschool age.

Subject of research is the manifestation of hyperactivity and the impact of the symptom on the child’s personality.

The purpose of this study: to study the features of cognitive development of children with attention deficit hyperactivity disorder.

Research hypothesis. Very often, children with hyperactive behavior have difficulties in mastering educational material, and many teachers tend to attribute this to insufficient intelligence. A psychological examination of children makes it possible to determine the level of intellectual development of the child, and in addition, possible violations of perception, memory, attention, and the emotional-volitional sphere. Typically, the results of psychological research prove that the level of intelligence of such children corresponds to the age norm. Knowledge of the specific features of the mental development of children with ADHD allows us to develop a model of correctional assistance for such children.

Taking into account the purpose of the study, its object and subject, as well as the formulated hypothesis, we decided the following tasks:

1. Analysis of literary sources on this topic in the process of theoretical research.

2. Experimental study of the level of development of mental (cognitive) processes in children with ADHD of preschool age, such as attention, thinking, memory, perception.

3. Study of emotional manifestations in children with hyperactivity disorder and attention deficit disorder.

To solve the problems, the following methods were used: literature analysis (works of domestic and foreign authors in the field of psychology, pedagogy, defectology and physiology on the research problem); theoretical analysis of the problem of hyperactivity; survey of teachers and educators; methods for diagnosing perception: the “What’s missing in these pictures?” technique, the “Find out who it is” technique, the “What objects are hidden in the pictures?” technique; methods for diagnosing attention: the “Find and Cross Out” technique, the “Place the Marks” technique, the “Remember and Dot the Dots” technique; methods for diagnosing memory: the “Learn words” technique, the “Memorizing 10 pictures” technique, the “How to patch a rug?” technique; methods for diagnosing thinking: a technique for identifying the ability to classify, a technique “What is superfluous here?”; rating scale of emotional manifestations.

Theoretical basis Our work was largely determined by the influence of fundamental research by Russian psychologists and defectologists: the cultural-historical theory of L.S. Vygotsky, his research on the nature of primary and secondary deviations in the mental development of children, the systemic structure of functions, their compensatory development in the process of specially organized activities, the theory of the relationship between psychological development in normal conditions and with disorders (T.A. Vlasova, Yu.A. Kulagina , A.R. Luria, V.I. Lubovsky, L.I. Solntseva, etc.).

Scientific novelty is determined by the methodological level of problem solving, which provides a scientific basis for the development of psychological foundations for the formation of the mental development of preschool children with hyperactivity and attention deficit, as a means of their personal development, qualitative restructuring of their behavior in the process of correctional and developmental work in line with solving the problem posed.

The following provisions are submitted for defense:

1. Attention deficit hyperactivity disorder is a group of pathological conditions that differ in etiology, pathogenesis and clinical manifestations. Its characteristic signs are increased excitability, emotional lability, diffuse mild neurological symptoms, moderate sensorimotor and speech disorders, perceptual disturbances, increased distractibility, behavioral difficulties, insufficient development of intellectual skills, and specific learning difficulties.

2. This syndrome occurs in approximately 20 percent of preschool children, with boys four times more likely than girls. Such children are characterized by constant motor restlessness, problems with concentration, impulsiveness, and “uncontrollable” behavior.

3. The level of development of cognitive processes (attention, memory, thinking, perception) of children with ADHD does not correspond to the age norm.

4. In providing psychological assistance to hyperactive children, working with their parents and teachers is crucial. It is necessary to explain to adults the child’s problems, to make it clear that his actions are not intentional, to show that without the help and support of adults, such a child will not be able to cope with his existing difficulties.

5. When working with such children, three main directions should be used: 1) on the development of deficit functions (attention, behavioral control, motor control); 2) to develop specific skills of interaction with adults and peers; 3) if necessary, work with anger should be carried out.

Theoretical and practical significance The research is determined by the need to study the characteristics of the mental development of preschool children with hyperactivity and attention deficit disorder, on the basis of which recommendations are developed for parents and educators. These studies can be used when working with hyperactive children.

Structure and scope of research work. The research work consists of an introduction, three chapters, a conclusion, set out in 63 pages of typewritten text. The bibliography has 39 names. Research work contains 9 drawings, 4 diagrams, 5 applications.

1. Hyperactivity and attention deficit disorder in childhood

1.1 Theoretical basis for the concept of ADHD

The first mention of hyperactive children appeared in specialized literature about 150 years ago. The German doctor Hoffman described the extremely active child, calling him “fidgety Phil.” The problem became more and more obvious and by the beginning of the 20th century caused serious concern among specialists - neurologists and psychiatrists.

In 1902, a fairly large article was dedicated to her in the Lancet magazine. Information about a large number of children whose behavior goes beyond the usual norms began to appear after the epidemic of Economo's encephalitis lethargica. This probably forced us to study the connection more closely: the child’s behavior in the environment and the functions of his brain. Since then, many attempts have been made to explain the cause, and various methods have been proposed for treating children who exhibited impulsivity and motor disinhibition, lack of attention, excitability, and uncontrollability of behavior.

Thus, in 1938, Dr. Levin, after long-term observations, came to the unexpected conclusion that the cause of severe forms of motor restlessness is organic brain damage, and mild forms are based on the incorrect behavior of parents, their insensitivity and a violation of mutual understanding with children. By the mid-1950s, the term “hyperdynamic syndrome” appeared, and doctors began to say with increasing confidence that the main cause of the disease was the consequences of early organic brain damage.

In the Anglo-American literature in the 1970s, the definition of “minimal brain dysfunction” was already clearly heard. It is used for children with learning or behavioral problems, attention disorders, who have a normal level of intelligence and mild neurological disorders that are not detected by standard neurological examination, or with signs of immaturity and delayed maturation of certain mental functions. To clarify the boundaries of this pathology, a special commission was created in the United States, which proposed the following definition of minimal brain dysfunction: this term refers to children with an average level of intelligence, with learning or behavioral disorders that are combined with pathology of the central nervous system.

Despite the efforts of the commission, there was still no consensus on the concepts.

After some time, children with similar disorders began to be divided into two diagnostic categories:

1) children with activity and attention disorders;

2) children with specific learning disabilities.

The latter include dysgraphia(isolated spelling disorder), dyslexia(isolated reading disorder), dyscalculia(numeracy disorder), as well as mixed scholastic skills disorder.

In 1966, S.D. Clement gave the following definition of this disease in children: “A disease with an average or close to average intellectual level, with behavioral disturbances from mild to severe degrees, combined with minimal deviations in the central nervous system, which can be characterized by various combinations of disorders of speech, memory, control of attention , motor functions". In his opinion, individual differences in children may be the result of genetic abnormalities, biochemical disorders, strokes in the perinatal period, diseases or injuries during periods of critical development of the central nervous system, or other organic causes of unknown origin.

In 1968, another term appeared: “hyperdynamic syndrome of childhood.” The term was adopted in the International Classification of Diseases, however, it was soon replaced by others: “attention disorder disorder”, “disorder of activity and attention” and, finally, "attention deficit hyperactivity disorder (ADHD), or "attention deficit hyperactivity disorder" (ADHD)". The latter, as it most fully covers the problem, is what domestic medicine currently uses. Although there are and may be found among some authors such definitions as “minimal cerebral dysfunction” (MCD).

In any case, no matter what we call the problem, it is very acute and must be solved. The number of such children is growing. Parents give up, kindergarten teachers and school teachers sound the alarm and lose their composure. The very environment in which children are growing up and being brought up today creates extremely favorable conditions for an increase in their various neuroses and mental disorders.

1.2 The concept of hyperactivity disorder and attention deficit disorder

Attention Deficit Disorder / hyperactivity is a dysfunction of the central nervous system (mainly the reticular formation of the brain), manifested by difficulties concentrating and maintaining attention, learning and memory disorders, as well as difficulties processing exogenous and endogenous information and stimuli.

Syndrome(from the Greek syndrome – accumulation, confluence). The syndrome is defined as a combined, complex disorder of mental functions that occurs when certain areas of the brain are damaged and is naturally caused by the removal of one or another component from normal functioning. It is important to note that the disorder naturally combines disorders of various mental functions that are internally interconnected. Also, the syndrome is a natural, typical combination of symptoms, the occurrence of which is based on a disturbance of a factor caused by a deficiency in the functioning of certain brain areas in the case of local brain lesions or brain dysfunction caused by other causes that do not have a local focal nature.

Hyperactivity –“Hyper...” (from the Greek Hyper - above, from above) is a component of complex words, indicating an excess of the norm. The word “active” came into Russian from the Latin “activus” and means “effective, active.” External manifestations of hyperactivity include inattention, distractibility, impulsiveness, and increased motor activity. Hyperactivity is often accompanied by problems in relationships with others, learning difficulties, and low self-esteem. At the same time, the level of intellectual development in children does not depend on the degree of hyperactivity and can exceed the age norm. The first manifestations of hyperactivity are observed before the age of 7 years and are more common in boys than in girls. Hyperactivity , occurring in childhood is a set of symptoms associated with excessive mental and motor activity. It is difficult to draw clear boundaries for this syndrome (i.e., a set of symptoms), but it is usually diagnosed in children who are characterized by increased impulsiveness and inattention; Such children are quickly distracted, they are equally easy to please and upset. They are often characterized by aggressive behavior and negativism. Due to such personality characteristics, hyperactive children find it difficult to concentrate on completing any tasks, for example, in school activities. Parents and teachers often face considerable difficulties in dealing with such children.

The main difference between hyperactivity and simply active temperament is that this is not a character trait of the child, but a consequence of mental development disorders in children. The risk group includes children born as a result of cesarean section, severe pathological births, artificial babies born with low birth weight, and premature babies.

Attention deficit hyperactivity disorder, also called hyperkinetic disorder, is observed in children aged 3 to 15 years, but most often manifests itself in preschool and primary school age. This disorder is a form of minimal brain dysfunction in children. It is characterized by pathologically low levels of attention, memory, and weakness of thought processes in general with a normal level of intelligence. Voluntary regulation is poorly developed, performance in classes is low, and fatigue is increased. Deviations in behavior are also noted: motor disinhibition, increased impulsivity and excitability, anxiety, negativism reactions, and aggressiveness. When starting systematic learning, difficulties arise in mastering writing, reading and counting. Against the background of educational difficulties and, often, a lag in the development of social skills, school maladaptation and various neurotic disorders arise.

Attention- this is a property or feature of human mental activity that provides the best reflection of some objects and phenomena of reality while simultaneously abstracting from others.

Basic functions of attention:

– activation of necessary and inhibition of currently unnecessary psychological and physiological processes;

– facilitating the organized and targeted selection of incoming information in accordance with current needs;

– ensuring selective and long-term concentration of mental activity on the same object or type of activity. Human attention has five main properties: stability, concentration, switchability, distribution and volume.

1. Sustainability of attention manifests itself in the ability to concentrate on any object or subject of activity for a long time without being distracted.

2. Focus(the opposite quality - absent-mindedness) is manifested in the differences that exist when concentrating attention on some objects and diverting it from others.

3. Switching attention is understood as its transfer from one object to another, from one type of activity to another. Two differently directed processes are functionally associated with the switchability of attention: inclusion and distraction of attention.

4. Distribution of attention consists in the ability to disperse it over a significant space and simultaneously perform several types of activities.

5. Attention span is determined by the amount of information that can simultaneously be stored in the area of increased attention (consciousness) of a person.

Attention deficit- inability to maintain attention on something that needs to be learned over a certain period of time.

1.3 Views and theories of domestic and foreign psychologists in the study of attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder is considered one of the main clinical variants of minimal brain dysfunction. For a long time, there was no single term to designate deviations in personality development. A large number of works reflected various concepts of the authors; the most common signs of the disease were used in the name of the syndrome: hyperactivity, inattention, static-motor failure.

The term “minimal brain dysfunction” (MCD) was officially introduced in 1962 at a special international conference in Oxford and has since been used in the medical literature. Since that time, the term MMD has been used to define conditions such as conduct disorders and learning difficulties that are not associated with significant intellectual disabilities. In the domestic literature, the term “minimal cerebral dysfunction” is currently used quite often.

L.T. Zhurba and E.M. Mastyukova (1980) in their studies used the term MMD to designate conditions of a non-progradient nature with the presence of mild, minimal brain damage in the early stages of development (up to 3 years) and manifested in partial or general disorders of mental activity, with the exception of general intellectual underdevelopment. The authors identified the most characteristic disorders in the form of a peculiar motor deficiency, speech disorders, perception, behavior, and specific learning difficulties.

In the USSR, the term “mental retardation” was used (Pevzner M. S., 1972), since 1975, publications appeared using the terms “partial brain dysfunction”, “mild brain dysfunction” (Zhurba L. T. et al., 1977) and “hyperactive child” (Isaev D.N. et al., 1978), “developmental disorder”, “improper maturation” (Kovalev V.V., 1981), “motor disinhibition syndrome”, and later – “hyperdynamic syndrome” ( Lichko A.E., 1985; Kovalev V.V., 1995). Most psychologists used the term “motor perception disorder” (Zaporozhets A.V., 1986).

Author 3. Trzhesoglava (1986) suggests considering MMD from the perspective of organic and functional disorders. He uses the terms “mild childhood encephalopathy”, “mild brain damage” from the position of an organic approach, and the terms “hyperkinetic child”, “hyperexcitability syndrome”, “attention deficit disorder” and others - from a clinical position, taking into account the manifestations of MMD or the most pronounced functional deficit.

Thus, in the study of MMD, a tendency towards their differentiation into separate forms is increasingly visible. Given that minimal brain dysfunction is still being studied, various authors describe this pathological condition using different terms.

In domestic psychological and pedagogical science, hyperactivity has also been given attention, but not priority. So, V.P. Kashchenko identified a wide range of character disorders, to which, in particular, he included “painfully expressed activity.” In his posthumously published book “Pedagogical Correction” we read: “Every child is characterized by mobility, both physical and mental, i.e. thoughts, desires, aspirations. We recognize this psychophysical property of his as normal, desirable, and extremely attractive. A child who is lethargic, inactive, and apathetic makes a strange impression. On the other hand, an excessive thirst for movement and activity (painfully expressed activity), brought to unnatural limits, also attracts our attention. We then note that the child is constantly on the move, cannot sit still for a single minute, fidgets in place, dangles his arms and legs, looks around, laughs, amuses himself, is always chatting about something, and does not pay attention to comments. The most fleeting phenomenon eludes his ear and eye: he sees everything, hears everything, but superficially... At school, such painful mobility creates great difficulties: the child is inattentive, plays pranks a lot, talks a lot, laughs endlessly at every trifle. He is immensely absent-minded. He cannot, or with the greatest difficulty, completes the work he has started. Such a child has no inhibitions, no proper self-control. All this is caused by abnormal muscle mobility, painful mental, as well as general mental activity. This psychomotor hyperactivity then finds its extreme expression in a mental illness called manic-depressive psychosis."

In our opinion, Kashchenko attributed the described phenomenon to “character shortcomings caused primarily by active-volitional elements,” also highlighting as independent shortcomings the lack of a specific goal, absent-mindedness, and impulsiveness of actions. Recognizing the painful conditionality of these phenomena, he proposed mainly pedagogical ways to manage them - from specially organized physical exercises to rational dosing of educational information to be assimilated. It is difficult to argue with Kashchenko’s recommendations, but their vagueness and generality raise doubts about their practical usefulness. “It is necessary to teach a child to desire and fulfill his desires, to insist on them, in a word, to fulfill them. To do this, it is useful to give him tasks of varying difficulty. These tasks should be accessible to the child for a long time and become more complex only as his strength develops.” This is undeniable, but hardly enough. It is quite obvious that it is not possible to solve the problem at this level.

Over the years, the impotence of pedagogical methods for correcting hyperactivity became more and more obvious. After all, explicitly or implicitly, these methods were based on the old idea of flaws in upbringing as the source of this problem, while its psychopathological nature required a different approach. Experience has shown that the school failure of hyperactive children is unfairly attributed to their mental inferiority, and their lack of discipline cannot be corrected by purely disciplinary methods. Sources of hyperactivity should be sought in disorders of the nervous system and corrective measures should be planned accordingly.

Research in this area has led scientists to the conclusion that in this case, the cause of behavioral disorders is an imbalance in the processes of excitation and inhibition in the nervous system. The “site responsible” for this problem, the reticular formation, was also localized. This section of the central nervous system is “responsible” for human energy, motor activity and expression of emotions, influencing the cerebral cortex and other overlying structures. Due to various organic disorders, the reticular formation may be in an overexcited state, and therefore the child becomes disinhibited.

The immediate cause of the disorder was called minimal brain dysfunction, i.e. many microdamages to brain structures (arising as a result of birth trauma, asphyxia of newborns and many similar reasons). In this case, there are no gross focal brain damage. Depending on the degree of damage to the reticular formation and disturbances from nearby parts of the brain, more or less pronounced manifestations of motor disinhibition occur. It was on the motor component of this disorder that domestic researchers focused their attention, calling it hyperdynamic syndrome.

In foreign science, mainly American, special attention was also paid to the cognitive component - attention disorders. A special syndrome has been identified - attention deficit hyperactivity disorder (ADHD). Long-term study of this syndrome has made it possible to reveal its extremely wide prevalence (according to some reports, it affects from 2 to 9.5% of school-age children worldwide), as well as to clarify data on the causes of its occurrence.

Various authors have tried to link childhood hyperactivity with specific morphological changes. Since the 1970s. Of particular interest to researchers are the reticular formation and the limbic system. Modern theories consider the frontal lobe and, above all, the prefrontal region as an area of anatomical defect in ADHD.

Ideas about frontal lobe involvement in ADHD are based on the similarity of clinical symptoms observed in ADHD and in patients with frontal lobe damage. Patients in both groups show marked variability and impaired regulation of behavior, distractibility, weakness of active attention, motor disinhibition, increased excitability and lack of impulse control.

The decisive role in the formation of the modern concept of ADHD was played by the work of the Canadian researcher of cognitive science orientation V. Douglas, who for the first time in 1972 considered attention deficit with an abnormally short period of its retention on any object or action as a primary defect in ADHD. When clarifying the key characteristics of ADHD, Douglas in her subsequent works, along with such typical manifestations of this syndrome as attention deficit, impulsiveness of motor and verbal reactions and hyperactivity, noted the need for significantly more than normal reinforcement for the development of behavioral skills in children with ADHD. She was one of the first to come to the conclusion that ADHD is caused by general disturbances in the processes of self-control and inhibition at the highest level of reaction of mental activity, but by no means by elementary disorders of perception, attention and motor reactions. Douglas’s work served as the basis for the introduction in 1980 of the diagnostic term “attention deficit hyperactivity disorder” in the American Psychiatric Association classification and then in the ICD-10 classification (1994). According to the most modern theory, dysfunction of the frontal structures may be caused by disturbances at the level of neurotransmitter systems. It is becoming increasingly clear that the main research in this area falls within the competence of neurophysiology and neuropsychology. This, in turn, dictates the corresponding specifics of corrective measures, which to this day, alas, remain insufficiently effective.

2. Etiology, mechanisms of development of ADHD. Clinical signs of ADHD. Psychological characteristics of children with ADHD. Treatment and correction of ADHD

2.1 Etiology of ADHD

The experience accumulated by researchers indicates not only the absence of a single name for this pathological syndrome, but also the absence of a consensus on the factors leading to the occurrence of attention deficit hyperactivity disorder. Analysis of available sources of information allows us to identify a number of causes of ADHD syndrome. However, the significance of each of these risk factors has not yet been sufficiently studied and requires clarification.

The onset of ADHD may be due to the influence of various etiological factors during the period of brain development up to 6 years. An immature, developing organism is most sensitive to harmful influences and least able to resist them.

Many authors (Badalyan L.O., Zhurba L.T., Vsevolozhskaya N.M., 1980; Veltishchev Yu.E., 1995; Khaletskaya O.V., 1998) consider the late stages of pregnancy and childbirth to be the most critical period. M. Haddres – Algra, H.J. Huisjes and B.C. Touwen (1988) divided all factors causing brain damage in children into biological (hereditary and perinatal), acting before birth, at the time of birth and after childbirth, and social, caused by the influence of the immediate environment. These studies confirm the relative difference in the influence of biological and social factors: from an early age (up to two years), biological factors of brain damage - the primary defect - are more important (Vygotsky L.S.). In the later period (from 2 to 6 years), social factors are a secondary defect (Vygotsky L.S.), and when both are combined, the risk of attention deficit hyperactivity disorder increases significantly.

A large number of works are devoted to studies proving the occurrence of attention deficit hyperactivity disorder due to minor brain damage in the early stages of development, i.e. in the pre- and intranatal periods.

Yu.I. Barashnev (1994) and E.M. Belousov (1994) consider “minor” disorders or injuries of brain tissue to be primary in the disease in the prenatal, perinatal and, less often, postnatal periods. Considering the high percentage of premature babies and the increase in the number of intrauterine infections, as well as the fact that in Russia in most cases childbirth occurs with injuries, the number of children with encephalopathies after childbirth is large.

Prenatal and intranatal lesions occupy a special place among neurological diseases in children. Currently, the frequency of perinatal pathology in the population is 15–25% and continues to grow steadily.

O.I. Maslova (1992) provides data on the unequal frequency of individual syndromes when characterizing the structure of organic lesions of the nervous system in children. These disorders were distributed as follows: in the form of motor skills disorders - 84.8%, mental disorders - 68.8%, speech disorders - 69.2% and convulsive seizures - 29.6%. Long-term rehabilitation of children with organic lesions of the nervous system in the first years of life in 50.5% of cases reduces the severity of disorders of motor skills, speech development and mental health in general.

It is believed that the occurrence of ADHD is promoted by asphyxia of newborns, threat of miscarriage, anemia of pregnant women, postmaturity, maternal use of alcohol and drugs during pregnancy, and smoking. A psychological follow-up study of children who suffered hypoxia revealed a decrease in learning ability in 67%, a decrease in the development of motor skills in 38% of children, and deviations in emotional development in 58%. Conversational activity was reduced in 32.8%, and in 36.2% of cases children had deviations in articulation.

Prematurity, morpho-functional immaturity, hypoxic encephalopathy, physical and emotional trauma to the mother during pregnancy, premature birth, as well as insufficient weight of the child determine the risk of behavioral problems, learning difficulties and disturbances in the emotional state, increased activity.

Research by Zavadenko N.N., 2000; Mamedalieva N.M., Elizarova I.P., Razumovskaya I.N. in 1990 it was found that the neuropsychic development of children born with insufficient body weight is much more often accompanied by various deviations: delayed psychomotor and speech development and convulsive syndrome.

Research results indicate that intensive medical, psychological, and pedagogical intervention before the age of 3 years leads to an increase in the level of cognitive development and a decrease in the risk of developing behavioral disorders. These data prove that obvious neurological disorders in the neonatal period and factors recorded in the intrapartum period have prognostic significance in the development of ADHD in later life.

A great contribution to the study of the problem was made by works suggesting the role of genetic factors in the occurrence of ADHD, evidence of which was the existence of familial forms of ADHD.

In support of the genetic etiology of ADHD syndrome, one can cite the follow-up observations of E.L. Grigorenko (1996). According to the author, hyperactivity is an innate characteristic along with temperament, biochemical parameters, and low reactivity of the central nervous system. Low excitability of the central nervous system E.L. Grigorenko explains the disorder in the reticular formation of the brain stem, inhibitors of the cerebral cortex, which causes motor restlessness. A fact proving the genetic predisposition of ADHD was the presence of symptoms in childhood in parents of children suffering from this disease.

The search for genes for predisposition to ADHD was carried out by M. Dekke et al. (2000) in a genetically isolated population in the Netherlands, which was founded 300 years ago (150 people) and currently includes 20 thousand people. In this population, 60 patients with ADHD were found, the pedigrees of many of them were traced back to the fifteenth generation and were reduced to a common ancestor.

Research by J. Stevenson (1992) proves that the heritability of attention deficit hyperactivity disorder in 91 pairs of identical and 105 pairs of fraternal twins is 0.76%.

The works of Canadian scientists (Barr S.L., 2000) talk about the influence of the SNAP-25 gene on the occurrence of increased activity and lack of attention in patients. An analysis of the structure of the SNAP-25 gene, which encodes synaptosomal protein in 97 nuclear families with increased activity and lack of attention, showed an association of some polymorphic sites in the SNAP-25 gene with the risk of developing ADHD.

There are also gender and age differences in the development of ADHD. According to V.R. Kuchma, I.P. Bryazgunova (1994) and V.R. Kuchma and A. G. Platonov, (1997) among boys 7–12 years old, signs of the syndrome occur 2–3 times more often than among girls. In their opinion, the high frequency of symptoms of the disease in boys may be due to the higher vulnerability of the male fetus to pathogenetic influences during pregnancy and childbirth. In girls, the cerebral hemispheres are less specialized, so they have a greater reserve of compensatory functions in case of damage to the central nervous system compared to boys.

Along with biological risk factors for ADHD, social factors are analyzed, for example, pedagogical neglect leading to ADHD. Psychologists I. Langmeyer and Z. Matejczyk (1984) distinguish among social factors of disadvantage, on the one hand, deprivation - mainly sensory and cognitive, on the other - social and cognitive. They include insufficient education of parents, single-parent families, deprivation or deformation of maternal care as unfavorable social factors.

J.V. Hunt, V. A Cooreg (1988) prove that the degree of severity of motor and visual-motor disorders, deviations in the development of speech and cognitive activity in the development of children depends on the education of the parents, and the frequency of such deviations depends on the presence of diseases during the neonatal period.

O.V. Efimenko (1991) attaches great importance in the occurrence of ADHD to the conditions of child development in infancy and preschool age. Children raised in orphanages or in an atmosphere of conflict and cold relationships between parents are more likely to experience neurotic breakdowns than children from families with a friendly atmosphere. The number of children with disharmonious and sharply disharmonious development among children in orphanages is 1.7 times greater than the number of similar children from families. It is also believed that the occurrence of ADHD is facilitated by delinquent parental behavior - alcoholism and smoking. 3. Trzhesoglava showed that 15% of children with ADHD had parents who suffered from chronic alcoholism.

Thus, at the present stage, the approaches developed by researchers to studying the etiology and pathogenesis of ADHD for the most part affect only certain aspects of the problem. Three main groups of factors determining the development of ADHD are considered: early damage to the central nervous system associated with the negative impact on the developing brain of various forms of pathology during pregnancy and childbirth, genetic factors and social factors.

Researchers do not yet have convincing evidence of the priority of physiological, biological or social factors in the formation of such changes in the higher parts of the brain, which are the basis of attention deficit hyperactivity disorder.

In addition to the above reasons, there are some other points of view on the nature of this disease. In particular, it is assumed that dietary habits and the presence of artificial food additives in foods can also affect the child’s behavior.

This problem has become relevant in our country due to significant imports of food products, including baby food, that have not undergone proper certification. It is known that most of them contain various preservatives and food additives.

Abroad, the hypothesis about a possible connection between food additives and hyperactivity was popular in the mid-70s. Message from Dr. V.F. Feingolda (1975) from San Francisco that 35-50% of hyperactive children showed significant improvement in behavior after eliminating foods containing food additives from their diet caused a real sensation. However, subsequent studies did not confirm these data.

For some time, refined sugar was also “under suspicion”. But careful research has not confirmed these “accusations.” Currently, scientists have come to the final conclusion that the role of food additives and sugar in the origin of attention deficit hyperactivity disorder is exaggerated.

However, if parents suspect any connection between a change in the child’s behavior and the consumption of a certain food product, then it can be excluded from the diet.

Information has appeared in the press that excluding foods containing large amounts of salicylates from the diet reduces a child’s hyperactivity.

Salicylates are found in the bark and leaves of plants and trees (olives, jasmine, coffee, etc.), and in small quantities in fruits (oranges, strawberries, apples, plums, cherries, raspberries, grapes). However, this information also needs to be carefully verified.

It can be assumed that the environmental distress that all countries are currently experiencing makes a certain contribution to the increase in the number of neuropsychiatric diseases, including ADHD. For example, dioxins are super-toxic substances that arise during the production, processing and combustion of chlorinated hydrocarbons. They are often used in industry and households and can lead to carcinogenic and psychotropic effects, as well as severe congenital anomalies in children. Environmental pollution with salts of heavy metals, such as molybdenum and cadmium, leads to a disorder of the central nervous system. Zinc and chromium compounds play the role of carcinogens.

Increased levels of lead, a powerful neurotoxin, in the environment may cause behavioral disorders in children. It is known that lead levels in the atmosphere are currently 2,000 times higher than during the Industrial Revolution.

There are many more factors that could be potential causes of the disorder. Usually, during diagnosis, a whole group of possible causes is identified, i.e. the nature of this disease is combined.

2.2 Mechanisms of development of ADHD

Due to the diversity of causes of the disease, there are a number of concepts describing the proposed mechanisms of its development.

Proponents of the genetic concept suggest the presence of congenital inferiority of the functional systems of the brain responsible for attention and motor control, in particular in the area of the frontal cortex and basal ganglia. Dopamine plays the role of a neurotransmitter in these structures. As a result of molecular genetic studies, abnormalities in the structure of the dopamine receptor and dopamine transporter genes were identified in children with severe hyperactivity and attention disorders.

However, clear experimental evidence to explain the mechanism of development (pathogenesis) of the syndrome from the standpoint of molecular genetics is not yet sufficient.

In addition to the genetic theory, there is also a neuropsychological theory. Children with the syndrome have deviations in the development of higher mental functions responsible for motor control, self-regulation, inner speech, attention and working memory. Violation of these “executive” functions, which are responsible for organizing activities, can lead to the development of attention deficit hyperactivity disorder, according to R.A. Barkley (1990) in his unified theory of ADHD.

As a result of neurophysiological studies - nuclear magnetic resonance, positron emission and computed tomography - scientists identified in these children deviations in the development of the frontal cortex, as well as the basal ganglia and cerebellum. These disorders are hypothesized to delay the maturation of functional brain systems responsible for motor control, self-regulation of behavior, and attention.

One of the latest hypotheses for the origin of the disease is a violation of the metabolism of dopamine and norepinephrine, which act as neurotransmitters in the central nervous system.

These connections affect the activity of the main centers of higher nervous activity: the center for control and inhibition of motor and emotional activity, the center for programming activities, the attention and RAM systems. In addition, these neurotransmitters perform positive stimulation functions and are involved in the formation of the stress response.

Thus, dopamine and norepinephrine are involved in the modulation of basic higher mental functions, which causes the occurrence of various neuropsychic disorders when their metabolism is disrupted.

Direct measurements of dopamine and its metabolites in the cerebrospinal fluid revealed a decrease in their content in patients with the syndrome. The content of norepinephrine, on the contrary, was increased.

In addition to direct biochemical measurements, evidence of the truth of the neurochemical hypothesis is the beneficial effect when treating sick children with psychostimulants, which, in particular, affect the release of dopamine and norepinephrine from nerve endings.

There are other hypotheses that describe the mechanisms of ADHD: the concept of diffuse cerebral dysregulation by O.V. Khaletskaya and V.M. Troshina, generator theory G.N. Kryzhanovsky (1997), theory of neurodevelopmental delay 3. Trzhesoglavy. But a definitive answer to the question of the pathogenesis of the disease has not yet been found.

2.3 Clinical features of ADHD

Most researchers note three main blocks of ADHD manifestation: hyperactivity, attention disorders, and impulsivity.
Signs of attention deficit hyperactivity disorder (ADHD) can be detected in very young children. Literally from the first days of life, a child may have increased muscle tone. Such children struggle to free themselves from swaddles and do not calm down well if they are swaddled tightly or even in tight clothing. They may suffer from frequent, repeated, unmotivated vomiting from early childhood. Not by regurgitation, which is typical in infancy, but by vomiting, when everything you eat comes right back in a fountain. Such spasms are a sign of a nervous system disorder. (And here it is important not to confuse them with pyloric stenosis).

Hyperactive children sleep poorly and little throughout the first year of life, especially at night. They have difficulty falling asleep, are easily excited, and cry loudly. They are extremely sensitive to all external stimuli: light, noise, stuffiness, heat, cold, etc. A little older, at two to four years old, they develop dyspraxia, the so-called clumsiness; the inability to concentrate on any object or phenomenon, even interesting to him, appears more clearly: he throws toys, cannot calmly listen to a fairy tale, or watch a cartoon.

But hyperactivity and problems with attention become most noticeable by the time the child enters kindergarten, and take on a completely threatening nature in elementary school.

Any mental process can be fully developed only if attention is formed. L.S. Vygotsky wrote that directed attention plays a huge role in the processes of abstraction, thinking, motivation, and directed activity.

Concept "hyperactivity" includes the following features:

The child is fussy and never sits quietly. You can often see how he moves his hands and feet for no reason, squirms in his chair, and constantly turns around.

The child is unable to sit still for a long time, jumps up without permission, walks around the classroom, etc.

A child’s physical activity, as a rule, does not have a specific goal. He just runs around, spins, climbs, tries to climb somewhere, although sometimes this is far from safe.

The child cannot play quiet games, rest, sit quietly and calmly, or do certain things.

The child is always focused on movement.

Often talkative.

Concept "carelessness" consists of the following features:

Typically, a child is not able to maintain (focus) attention on details, which is why he makes mistakes when performing any tasks (at school, kindergarten).

The child is not able to listen attentively to speech addressed to him, which gives the impression that he generally ignores the words and comments of others.

The child does not know how to complete the work being done. It often seems that this is his way of protesting because he doesn't like the job. But the point is that the child is simply not able to learn the rules of work offered to him by the instructions and adhere to them.

The child experiences enormous difficulties in organizing his own activities (it doesn’t matter whether it’s building a house out of blocks or writing a school essay).

The child avoids tasks that require prolonged mental stress.

A child often loses his things, items needed at school and at home: in kindergarten he can never find his hat, in class he can never find a pen or a diary, although his mother has previously collected everything and put it in one place.

The child is easily distracted by extraneous stimuli.

In order for a child to be diagnosed with inattention, he must have at least six of the listed signs that persist for at least six months and are expressed constantly, which does not allow the child to adapt to a normal age environment.

Impulsiveness is expressed in the fact that the child often acts without thinking, interrupts others, and can get up and leave the classroom without permission. In addition, such children do not know how to regulate their actions and obey rules, wait, often raise their voices, and are emotionally labile (mood often changes).

Concept "impulsiveness" includes the following features:

The child often answers questions without thinking, without listening to them to the end, and sometimes simply shouts out the answers.

The child has difficulty waiting his turn, regardless of the situation and environment.

The child usually disturbs others, interferes in conversations, games, and pesters others.

We can talk about hyperactivity and impulsivity only if at least six of the above symptoms are present and they persist for at least six months.

By adolescence, increased motor activity in most cases disappears, but impulsivity and attention deficit persist. According to the results of the study by N.N. Zavadenko, behavioral disorders persist in almost 70% of adolescents and 50% of adults who were diagnosed with attention deficit in childhood. A characteristic feature of the mental activity of hyperactive children is cyclicality. Children can work productively for 5-15 minutes, then the brain rests for 3-7 minutes, accumulating energy for the next cycle. At this moment, the child is distracted and does not respond to the teacher. Then mental activity is restored, and the child is ready to work within 5–15 minutes. Children with ADHD have a “flickering” consciousness and can “drop in” and “fall out” of it, especially in the absence of motor stimulation. When the vestibular system is damaged, they need to move, twist and constantly turn their head to remain “conscious”. In order to maintain concentration, children use an adaptive strategy: they activate their balance centers with the help of physical activity. For example, leaning back on a chair so that only its back legs touch the floor. The teacher requires students to “sit up straight and not be distracted.” But for such children these two requirements come into conflict. If their head and body are motionless, their level of brain activity decreases.

Through correction through reciprocal movement exercises, damaged tissue in the vestibular system can be replaced by new tissue as new nerve networks develop and myelinate. It has now been established that motor stimulation of the corpus callosum, cerebellum and vestibular apparatus of children with ADHD leads to the development of the function of consciousness, self-control and self-regulation.

The listed violations lead to difficulties in mastering reading, writing, and counting. N.N. Zavadenko notes that 66% of children diagnosed with ADHD are characterized by dyslexia and dysgraphia, and 61% of children have signs of dyscalculia. Delays of 1.5–1.7 years are observed in mental development.

In addition, hyperactivity is characterized by poor development of fine motor coordination and constant, erratic, awkward movements caused by immaturity of interhemispheric interaction and high levels of adrenaline in the blood. Hyperactive children are also characterized by constant chatter, indicating

to a lack of development of inner speech, which should control social behavior.

At the same time, hyperactive children often have extraordinary abilities in various areas, are smart and show a keen interest in their surroundings. The results of numerous studies show good general intelligence of such children, but the listed features of their status do not contribute to its development. Among hyperactive children there may also be gifted ones. Thus, D. Edison and W. Churchill belonged to hyperactive children and were considered difficult teenagers.

An analysis of the age-related dynamics of ADHD showed two surges in the manifestation of the syndrome. The first is celebrated at 5–10 years and occurs during the period of preparation for school and the beginning of education, the second – at 12–15 years. This is due to the dynamics of the development of higher nervous activity. Ages 5.5–7 and 9–10 years are critical periods for the formation of brain systems responsible for mental activity, attention, and memory. YES. Farber notes that by the age of 7, a change in stages of intellectual development occurs, and conditions are formed for the formation of abstract thinking and voluntary regulation of activity. The activation of ADHD at 12–15 years of age coincides with puberty. The hormonal surge affects behavior and attitudes towards learning.

According to modern scientific data, among boys aged 7–12 years, signs of the syndrome are diagnosed 2–3 times more often than among girls. Among teenagers this ratio is 1:1, and among 20–25 year olds it is 1:2 with a predominance of girls. In the clinic, the ratio of boys to girls varies from 6:1 to 9:1. Girls have more pronounced social maladjustment, learning difficulties, and personality disorders.

Based on the severity of symptoms, doctors classify the disease into three groups: mild, moderate and severe. In a mild form, the symptoms, the presence of which is necessary for diagnosis, are minimally expressed, and there are no disturbances in school and social life. In a severe form of the disease, many symptoms are revealed to a significant degree of severity, there are serious educational difficulties, problems in social life. Moderate degree is a symptomatology between mild and severe forms of the disease.

Thus, hyperactivity syndrome often includes cerebrasthenic, neurosis-like, intellectual-mnestic disorders, as well as psychopath-like manifestations such as increased motor activity, impulsivity, attention deficit, and aggressiveness.

2.4 Psychological characteristics of children with ADHD

The lag in the biological maturation of the central nervous system in children with ADHD and, as a consequence, in higher brain functions (mainly the regulatory component), does not allow the child to adapt to new living conditions and tolerate intellectual stress normally.

O.V. Khaletskaya (1999) analyzed the state of higher brain functions in healthy and sick children with ADHD aged 5–7 years and came to the conclusion that there were no pronounced differences in them. At 6–7 years of age, differences are especially pronounced in such functions as auditory-motor coordination and speech, so it is advisable to conduct dynamic neuropsychological monitoring of children with ADHD from the age of 5, using individual rehabilitation techniques. This will overcome the delay in maturation of higher brain functions in this group of children and prevent the formation and development of maladaptive school syndrome.

There is a discrepancy between the actual level of development and the performance that can be expected based on IQ. Quite often, hyperactive children are smart and quickly “grab” information and have extraordinary abilities. Among children with ADHD there are truly talented children, but cases of mental development delays in this category of children are not uncommon. The most significant thing is that children’s intelligence is preserved, but the features that characterize ADHD - restlessness, restlessness, many unnecessary movements, lack of focus, impulsiveness of actions and increased excitability - are often combined with difficulties in acquiring educational skills (reading, counting, writing). This leads to pronounced school maladjustment.

Severe impairments in cognitive processes are associated with disorders of auditory gnosis. Changes in auditory gnosis are manifested in the inability to correctly evaluate sound complexes consisting of a series of sequential sounds, the inability to reproduce them and deficiencies in visual perception, difficulties in the formation of concepts, infantility and vagueness of thinking, which are constantly influenced by momentary impulses. Motor discordance is associated with poor eye-hand coordination and negatively affects the ability to write easily and correctly.

L.A. Research Yasyukova (2000) show the specifics of the intellectual activity of a child with ADHD, consisting of cyclicality: voluntary productive work does not exceed 5–15 minutes, after which children lose control over mental activity; then, within 3–7 minutes, the brain accumulates energy and strength for the next duty cycle.

It should be noted that fatigue has a double biological effect: on the one hand, it is a protective protective reaction against extreme exhaustion of the body, on the other hand, fatigue stimulates recovery processes and pushes the boundaries of functional capabilities. The longer the child works, the shorter
productive periods and longer rest periods become available until complete exhaustion occurs. Then sleep is necessary to restore mental performance. During the period of “rest” of the brain, the child ceases to understand, comprehend and process incoming information. It is not fixed anywhere and does not linger, therefore
the child does not remember what he was doing at that time, does not notice that there were any breaks in his work.

Mental fatigue is more common in girls, and in boys it manifests itself by the age of 7. Girls also have a reduced level of verbal and logical thinking.

Memory in children with ADHD may be normal, but due to exceptional instability of attention, “gaps in well-learned” material are observed.

Disorders of short-term memory can be detected in a decrease in the volume of memorization, increased inhibition by extraneous stimuli, and delayed memorization. At the same time, increased motivation or organization of material gives a compensatory effect, which indicates the preservation of cortical function in relation to memory.

At this age, speech disorders begin to attract attention. It should be noted that the maximum severity of ADHD coincides with critical periods of psychospeech development in children.

If the regulatory function of speech is impaired, the adult’s speech does little to correct the child’s activity. This leads to difficulties in consistently performing certain intellectual operations. The child does not notice his mistakes, forgets the final task, easily switches to side or non-existent stimuli, and cannot stop side associations.

Particularly common in children with ADHD are speech disorders such as delayed speech development, insufficient motor function of the articulatory apparatus, excessively slow speech, or, conversely, explosiveness, voice and speech breathing disorders. All these violations cause defects in the sound-pronunciation side of speech, its phonation, limited vocabulary and syntax, and insufficient semantics.

Other disorders, such as stuttering, are also noted. Stuttering does not have clear age trends, however, it is most often observed at 5 and 7 years of age. Stuttering is more common in boys and occurs in them much earlier than in girls, and is equally present in all age groups. In addition to stuttering, the authors also highlight the talkativeness of this category of children.

Increased switching from one activity to another occurs involuntarily, without adjustment to the activity and subsequent control. The child is distracted by minor sound and visual stimuli, which are ignored by other peers.

A tendency towards a pronounced decrease in attention is observed in unusual situations, especially when it is necessary to act independently. Children do not show persistence either during classes or in games, and cannot watch their favorite TV show to the end. In this case, there is no switching of attention, so activities that quickly replace each other are carried out in a reduced, poor quality and fragmentary manner, however, when errors are pointed out, children try to correct them.

Attention disturbance in girls reaches its maximum severity by the age of 6 and becomes the leading disorder in this age period.

The main manifestations of hyperexcitability are observed in various forms of motor disinhibition, which is aimless, unmotivated, situationless and usually not controlled by either adults or peers.

Such increased motor activity, turning into motor disinhibition, is one of the many symptoms that accompany child developmental disorders. Purposeful motor behavior is less active than in healthy children of the same age.

In the area of motor abilities, coordination disorders are detected. Research results show that motor problems arise already in preschool age. In addition, there are general difficulties in perception, which affects the mental abilities of children, and, consequently, the quality of education. Fine motor skills, sensorimotor coordination, and manual dexterity are most commonly affected. Difficulties associated with maintaining balance (while standing, skating, roller skating, biking), impaired visual-spatial coordination (inability to play sports, especially with a ball) are the causes of motor clumsiness and an increased risk of injury.

Impulsivity is manifested in sloppy execution of a task (despite effort, doing everything correctly), incontinence in words, deeds and actions (for example, shouting from the seat during class, inability to wait for one’s turn in games or other activities), inability to lose, excessive persistence in defending one’s interests (despite the demands of an adult). With age, the manifestations of impulsivity change: the older the child, the more pronounced the impulsiveness is and the more noticeable to others.

One of the characteristic features of children with ADHD is impairment of social adaptation. These children typically have a lower level of social maturity than is typical for their age. Affective tension, a significant amplitude of emotional experience, difficulties arising in communication with peers and adults lead to the fact that the child easily forms and fixes negative self-esteem, hostility towards others, and neurosis-like and psychopathological disorders arise. These secondary disorders aggravate the clinical picture of the condition, increase maladjustment and lead to the formation of a negative “I-concept”.

Children with the syndrome have impaired relationships with peers and adults. In mental development, these children lag behind their peers, but strive to lead, behave aggressively and demandingly. Impulsive hyperactive children quickly react to a prohibition or harsh remark, responding with harshness and disobedience. Attempts to restrain them lead to actions based on the “released spring” principle. Not only those around him suffer from this, but also the child himself, who wants to fulfill his promise, but does not keep it. Such children's interest in playing quickly disappears. Children with ADHD love to play destructive games, cannot concentrate during play, and conflict with their friends, despite the fact that they love the team. Ambivalent forms of behavior most often manifest themselves in aggressiveness, cruelty, tearfulness, hysteria and even sensory dullness. Because of this, children with attention deficit hyperactivity disorder have few friends, although these children are extroverts: they look for friends, but quickly lose them.

The social immaturity of such children is manifested in a preference for building play relationships with younger children. Relationships with adults are difficult. It is difficult for children to listen to an explanation to the end; they are constantly distracted, especially if they are not interested. These children ignore both encouragement from adults and punishment. Praise does not stimulate good behavior; therefore, rewards must be very justified, otherwise the child will behave worse. However, it must be remembered that a hyperactive child needs praise and approval from an adult to strengthen his self-confidence.

A child with the syndrome is not able to master his role and cannot understand how he should behave. Such children behave familiarly, do not take into account specific circumstances, and cannot adapt and accept the rules of behavior in a specific situation.

Increased excitability causes difficulty in acquiring normal social skills. Children have trouble falling asleep even if they follow a routine, eat slowly, dropping and spilling everything, as a result of which the process of eating becomes a source of daily conflicts in the family.

Harmonization of the personality development of children with ADHD depends on the micro and macro environment. If mutual understanding, patience and a warm attitude towards the child are maintained in the family, then after ADHD is cured, all negative aspects of behavior disappear. Otherwise, even after treatment, the character pathology will remain, and perhaps even intensify.

The behavior of such children is characterized by a lack of self-control. The desire for independent action (“I want it this way”) turns out to be a stronger motive than any rules. Knowledge of the rules does not act as a significant motive for one’s own actions. The rule remains known, but subjectively meaningless.

It is important to emphasize that society’s rejection of hyperactive children leads to the development of a sense of rejection in them, alienates them from the team, and increases instability, temper and intolerance to failure. A psychological examination of children with the syndrome reveals increased anxiety, restlessness, internal tension, and a sense of fear in most of them. Children with ADHD are more prone to depression than others and are easily upset by failures.

The emotional development of the child lags behind the normal indicators for this age group. The mood quickly changes from elated to depressed. Sometimes there are causeless attacks of anger, rage, anger, not only in relation to others, but also towards oneself. The child is characterized by low self-esteem, low self-control and voluntary regulation, as well as an increased level of anxiety.

A calm environment and guidance from adults lead to the fact that the activities of hyperactive children become successful. Emotions have an extremely strong influence on the activities of these children. Emotions of medium intensity can activate it, but with a further increase in the emotional background, the activity can be completely disorganized, and everything that has just been learned can be destroyed.

Thus, older preschoolers with ADHD demonstrate a decrease in the voluntariness of their own activity as one of the main components of the child’s development, causing a decrease and immaturity in the development of the following functions: attention, praxis, orientation, and weakness of the nervous system.

Ignorance that a child has functional abnormalities in the functioning of brain structures and the inability to create an appropriate mode of education and life in general in preschool age give rise to many problems in elementary school.

2.5 Treatment and correction of ADHD

The goal of therapy is to reduce behavioral problems and learning difficulties. To do this, first of all, it is necessary to change the child’s environment in the family, school and create favorable conditions for correcting the symptoms of the disorder and overcoming the lag in the development of higher mental functions.

Treatment of children with attention deficit hyperactivity disorder should include a set of techniques, or, as experts say, be “multimodal.” This means that a pediatrician, a psychologist (and if this is not the case, then the pediatrician must have certain knowledge in the field of clinical psychology), teachers and parents should participate in it. Only the collective work of the above-mentioned specialists will achieve a good result.

“Multimodal” treatment includes the following stages:

Educational conversations with the child, parents, teachers;

Training parents and teachers in behavioral programs;

Expanding the child’s social circle through visiting various clubs and sections;

Special training in case of learning difficulties;

Drug therapy;

Autogenic training and suggestive therapy.

At the beginning of treatment, the doctor and psychologist must carry out educational work. The meaning of the upcoming treatment must be explained to the parents (preferably also to the class teacher) and the child.

Adults often do not understand what is happening to the child, but his behavior irritates them. Not knowing about the hereditary nature of ADHD, they explain the behavior of their son (daughter) as “wrong” upbringing and blame each other. Specialists should help parents understand the child’s behavior, explain what they can realistically hope for and how to behave with the child. It is necessary to try all the variety of methods and choose the most effective for these disorders. The psychologist (doctor) must explain to parents that improvement in the child’s condition depends not only on the prescribed treatment, but to a large extent on a kind, calm and consistent attitude towards him.

Children are referred for treatment only after a comprehensive examination.

Drug therapy

Abroad, drug therapy for ADHD is used more than widely; for example, in the USA, the use of drugs is a key aspect of treatment. But there is still no consensus on the effectiveness of treatment with drugs, and there is no single regimen for taking them. Some doctors believe that the prescribed drugs bring only a short-term effect, others deny this.

For behavioral disorders (increased motor activity, aggression, excitability), psychostimulants are most often prescribed, less often antidepressants and antipsychotics.

Psychostimulants have been used to treat motor disinhibition and attention disorders since 1937 and are still the most effective drugs for this disease: in all age groups (children, adolescents, adults) improvement is observed in 75%. cases. This group of drugs includes methylphenidate (commercial name Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert).

When taken, hyperactive children improve their behavior, cognitive and social functions: they become more attentive, successfully complete tasks in class, their academic performance increases, and their relationships with others improve.

The high effectiveness of psychostimulants is explained by their wide range of neurochemical actions, which are aimed primarily at the dopamine and noradrenergic systems of the brain. It is not completely known whether these drugs increase or decrease the content of dopamine and norepinephrine in synaptic terminals. It is assumed that they have a general “irritating” effect on these systems, which leads to the normalization of their functions. There has been a proven direct correlation between improved catecholamine metabolism and a reduction in ADHD symptoms.

In our country, these drugs have not yet been registered and are not used. No other highly effective medications have yet been created. Our psychoneurologists continue to prescribe aminalon, sidnocarb and other neuroleptics with a hyperinhibitory effect that does not improve the condition of these children. In addition, aminalone has adverse effects on the liver. Several studies have been conducted to study the effect of Cerebrolysin and other nootropics on ADHD symptoms, but these drugs have not yet been introduced into widespread practice.

Only a doctor who knows the child’s condition, the presence or absence of certain somatic diseases, can prescribe the drug in the appropriate dosage, and will monitor the child, identifying possible side effects of the drug. And they can be observed. These include loss of appetite, insomnia, increased heart rate and blood pressure, and drug addiction. Less common are abdominal pain, dizziness, headaches, drowsiness, dry mouth, constipation, irritability, euphoria, bad mood, anxiety, nightmares. There are hypersensitive reactions in the form of skin rashes and swelling. Parents should immediately pay attention to these signs and notify their doctor as soon as possible.

In the early 70s. There have been reports in medical periodicals that long-term use of methylphenidate or dextroamphetamine leads to child growth retardation. However, further repeated studies have not confirmed the connection between growth retardation and the effect of these drugs. 3. Trzhesoglava sees the reason for growth retardation not in the action of stimulants, but in the general developmental lag of these children, which can be eliminated with timely correction.

In one of the latest studies conducted by American specialists in a group of children from 6 to 13 years old, it was shown that methylphenidate is most effective in young children. Therefore, the authors recommend prescribing this drug as early as possible, from 6–7 years of age.

There are several treatment strategies for the disease. Drug therapy can be carried out continuously, or the “drug holiday” method is used, i.e. The medicine is not taken on weekends and during holidays.

However, you cannot rely only on medications, since:

Not all patients experience the expected effect;

Psychostimulants, like any medications, have a number of side effects;

The use of medications alone does not always improve a child's behavior.

Numerous studies have shown that psychological and pedagogical methods can successfully and longer-term correct behavior disorders and learning difficulties than the use of medications. Medicines are prescribed no earlier than 6 years of age and only for individual indications: in cases where impaired cognitive functions and deviations in the child’s behavior cannot be overcome with the help of psychological, pedagogical and psychotherapeutic correction methods.

The effective use of central nervous system stimulants abroad for decades has made them “magic pills,” but their short duration of action remains a serious drawback. Long-term studies have shown that children with the syndrome who underwent courses of psychostimulants for several years did not differ in academic performance from sick children who did not receive any therapy. And this despite the fact that clear positive dynamics were observed directly during treatment.

The short duration of action and side effects of the use of psychostimulants led to their excessive prescription in the 1970–1980s. Already in the early 90s, it was replaced by an individual prescription with an analysis of each specific case and periodic assessment of the success of treatment.

In 1990, the American Academy of Pediatrics opposed the unilateral use of medications in the treatment of attention deficit hyperactivity disorder. The following resolution was passed: “Drug therapy should be preceded by pedagogical and behavioral correction...”. In accordance with this, cognitive behavioral therapy has become a priority, and medications are used only in combination with psychological and pedagogical methods.

Behavioral psychotherapy

Among the psychological and pedagogical methods for correcting attention deficit disorder, the main role is given to behavioral psychotherapy. There are psychological assistance centers abroad that provide special training for parents, teachers and children's doctors in these techniques.

The key point of a behavioral correction program is changing the child’s environment at school and at home in order to create favorable conditions for overcoming the lag in the development of mental functions.

The home correction program includes:

changes in the behavior of an adult and his attitude towards the child(demonstrate calm behavior, avoid words “no” and “no”, build relationships with the child on trust and mutual understanding);

change in the psychological microclimate in the family(adults should quarrel less, devote more time to the child, and spend leisure time with the whole family);

organization of the daily routine and place for classes ;

special behavioral program, providing for the predominance of methods of support and reward.

The home program is behaviorally focused, while the school program focuses on cognitive therapy to help children cope with learning difficulties.

The school correction program includes:

change of environment(the child’s place in the classroom is next to the teacher, changing the lesson mode to include minutes of active recreation, regulating relationships with classmates);

creating positive motivation and situations of success ;

correction of negative behaviors, in particular unmotivated aggression;

regulation of expectations(this also applies to parents), since positive changes in the child’s behavior do not appear as quickly as others would like.

Behavioral programs require significant skill; adults have to use all their imagination and experience in communicating with children in order to maintain the motivation of a constantly distracted child during classes.

Corrective methods will be effective only if there is close cooperation between family and school, which must necessarily include the exchange of information between parents and teachers through joint seminars, training courses, etc. Success in treatment will be guaranteed provided that common principles are maintained in relation to the child at home and at school: a “reward” system, help and support from adults, participation in joint activities. Continuity of therapeutic therapy at school and at home is the main key to success.

In addition to parents and teachers, great assistance in organizing a correction program should be provided by doctors, psychologists, and social educators—those who can provide professional assistance in individual work with such a child.

Correctional programs should be aimed at the age of 5–8 years, when the compensatory capabilities of the brain are great and a pathological stereotype has not yet formed.

Based on literature data and our own observations, we have developed specific recommendations for parents and teachers on working with hyperactive children (see paragraph 3.6).

It must be remembered that negative parenting methods are ineffective for these children. The peculiarities of their nervous system are such that the threshold of sensitivity to negative stimuli is very low, so they are not susceptible to reprimands and punishment, and do not easily respond to the slightest praise. Although the methods of rewarding and encouraging the child must be constantly changed.

A home rewards and rewards program includes the following:

1. Every day the child is given a specific goal that he must achieve.

2. The child’s efforts in achieving this goal are encouraged in every possible way.

3. At the end of the day, the child’s behavior is assessed in accordance with the results achieved.

4. Parents periodically inform the attending physician about changes in the child’s behavior.

5. When a significant improvement in behavior is achieved, the child receives a long-promised reward.

Examples of goals set for a child can be: doing homework well, helping a weaker classmate with homework, exemplary behavior, cleaning his room, preparing lunch, shopping, and others.

In a conversation with a child, and especially when you give him tasks, avoid directive instructions, turn the situation in such a way that the child feels: he will do something useful for the whole family, they completely trust him, they rely on him. When communicating with your son or daughter, avoid constant taunts such as “sit still” or “don’t talk when I’m talking to you” and other things that are unpleasant for him.

A few examples of incentives and rewards: allow your child to watch TV in the evening for half an hour longer than the allotted time, treat him to a special dessert, give him the opportunity to participate in games with adults (lotto, chess), allow him to go to a disco one more time, buy that thing he has been wanting for a long time dreams.

If a child behaves exemplary during the week, he should receive an additional reward at the end of the week. This could be some kind of trip with parents out of town, an excursion to the zoo, to the theater and others.

The above version of behavioral training is ideal and its use is not always possible in our country at present. But parents and teachers can use individual elements of this program, taking its basic idea: rewarding the child for achieving set goals. Moreover, it does not matter in what form it will be presented: material reward or simply an encouraging smile, a kind word, increased attention to the child, physical contact (stroking).

Parents are encouraged to write a list of what they expect from their child in terms of behavior. This list is explained to the child in an accessible manner. After this, everything written is strictly observed, and the child is rewarded for success in completing it. Physical punishment must be avoided.

It is believed that drug therapy in combination with behavioral techniques is most effective.

Special training

If it is difficult for a child to study in a regular class, then by decision of the medical-psychological-pedagogical commission he is transferred to a specialized class.

A child with ADHD may benefit from learning in special settings that suit his or her abilities. The main reasons for poor performance in this pathology are inattention and lack of proper motivation and determination, sometimes combined with partial delays in the development of school skills. Unlike the usual “mental retardation,” they are a temporary phenomenon and can be successfully leveled out with intensive training. If there are partial delays, a correction class is recommended, and with normal intelligence, a catch-up class is recommended.

A prerequisite for educating children with ADHD in correctional classes is the creation of favorable conditions for development: a class size of no more than 10 people, training under special programs, the availability of appropriate textbooks and developmental materials, individual lessons with a psychologist, speech therapist and other specialists. It is advisable to isolate the classroom from external sound stimuli; it should contain a minimum number of distracting and stimulating objects (paintings, mirrors, etc.); students should sit separately from each other; students with more pronounced motor activity should be seated at subject tables closer to the teacher to prevent their influence on other children. The duration of classes is reduced to 30–35 minutes. Autogenic training classes are required throughout the day.

At the same time, as experience shows, organizing a class exclusively for children with ADHD is inappropriate, since in their development they must rely on successful students. This is especially true for first-graders, who develop mainly through imitation and following authorities.

Recently, due to insufficient funding, the organization of correction classes has been irrational. Schools are not able to provide these classes with everything necessary, and also to allocate specialists to work with children. Therefore, there is a controversial point of view on the organization of specialized classes for hyperactive children who have a normal level of intelligence and are only slightly behind their peers in development.

At the same time, it must be remembered that the absence of any correction at all can lead to the development of a chronic form of the disease, and therefore to problems in the lives of these children and those around them.

Children with the syndrome require constant medical and pedagogical assistance (“advisory support”). In some cases, for 1–2 quarters they should be transferred to a sanatorium department, where, along with training, therapeutic measures will also be carried out.

After treatment, the average duration of which, according to 3. Tresoglava, is 17–20 months, children can return to regular classes.

Physical activity

Treatment of children with ADHD must include physical rehabilitation. These are special exercises aimed at restoring behavioral reactions, developing coordinated movements with voluntary relaxation of the skeletal and respiratory muscles.

The positive effect of physical exercise, especially on the cardiovascular and respiratory systems of the body, is well known to all doctors.

The muscular system responds by increasing working capillaries, while the supply of oxygen to tissues increases, resulting in improved metabolism between muscle cells and capillaries. Lactic acid is easily removed, so muscle fatigue is prevented.

Subsequently, the training effect affects the increase in the number of main enzymes that affect the kinetics of biochemical reactions. Myoglobin content increases. It is not only responsible for storing oxygen, but also serves as a catalyst, increasing the rate of biochemical reactions in muscle cells.

Physical exercise can be divided into two types - aerobic and anaerobic. An example of the former is steady running, and the latter is barbell training. Anaerobic exercise increases muscle strength and mass, while aerobic exercise improves the cardiovascular and respiratory systems and increases endurance.

Most of the experiments conducted have shown that the mechanism for improving well-being is associated with increased production during prolonged muscle activity of special substances - endorphins, which have a beneficial effect on a person’s mental state.

There is compelling evidence that exercise is beneficial for a range of health conditions. They can not only prevent the occurrence of acute attacks of the disease, but also alleviate the course of the disease and make the child “virtually” healthy.

Countless articles and books have been written about the benefits of exercise. But there is not much evidence-based research on this topic.

Czech and Russian scientists conducted a series of studies on the state of the cardiovascular system in 30 sick and 17 healthy children.

An orthoclinostatic study revealed higher lability of the autonomic nervous system in 65% of sick children compared to the control group, which suggests a decrease in orthostatic adaptation in children with the syndrome.

An “imbalance” in the innervation of the cardiovascular system was also identified when determining physical performance using a bicycle ergometer. The child pedaled for 6 minutes at three types of submaximal load (1–1.5 watts/kg body weight) with a one-minute break before the next load. It has been shown that during physical activity of submaximal intensity, the heart rate in children with the syndrome is more pronounced compared to the control group. At maximum loads, the functionality of the circulatory system was leveled and the maximum oxygen transport corresponded to the level in the control group.

Since the physical performance of these children during the research practically did not differ from the level of the control group, physical activity can be prescribed to them in the same volume as healthy children.

It is important to keep in mind that not all types of physical activity may be beneficial for hyperactive children. Games where the emotional component is strongly expressed (competitions, demonstration performances) are not shown for them. Physical exercises that are aerobic in nature are recommended in the form of long, uniform training of light and medium intensity: long walks, jogging, swimming, skiing, cycling and others.

Particular preference should be given to long, steady running, which has a beneficial effect on the mental state, relieves tension, and improves well-being.

Before a child begins to engage in physical exercise, he must undergo a medical examination in order to exclude diseases, primarily of the cardiovascular system.

When giving recommendations on a rational motor regimen for children with attention deficit hyperactivity disorder, the doctor must take into account not only the characteristics of this disease, but also the height and weight data of the child’s body, as well as the presence of physical inactivity. It is known that only muscle activity creates the prerequisites for normal development of the body in childhood, and children with the syndrome, due to general developmental delay, often lag behind healthy peers in height and body weight.

Psychotherapy

Attention deficit hyperactivity disorder is a disease not only of the child, but also of adults, especially the mother, who most often comes into contact with it.

Doctors have long noticed that the mother of such a child is overly irritable, impulsive, and often has a low mood. To prove that this is not just a coincidence, but a pattern, special studies were conducted, the results of which were published in 1995 in the journal Family Medicine. It turned out that the frequency of so-called major and minor depression occurs among ordinary mothers in 4–6% and 6–14% of cases, respectively, and among mothers who had hyperactive children – in 18 and 20% of cases, respectively. Based on these data, scientists concluded that mothers of hyperactive children must undergo a psychological examination.

Often, mothers with children with the syndrome experience an asthenoneurotic condition that requires psychotherapeutic treatment.

There are many psychotherapeutic techniques that can benefit both mother and child. Let's look at some of them.

Visualization

Experts have proven that the reaction to the mental reproduction of an image is always stronger and more stable than to the verbal designation of this image. Consciously or not, we constantly create images in our imagination.

Visualization refers to relaxation, mental merging with an imaginary object, picture or process. It has been shown that visualization of a certain symbol, picture, or process has a beneficial effect and creates conditions for restoring mental and physical balance.

Visualization is used to relax and enter a hypnotic state. It is also used to stimulate the body’s defense system, increase blood circulation in a certain area of the body, slow down the pulse, etc. .

Meditation

Meditation is one of the three main elements of yoga. This is a conscious fixation of attention on a moment in time. During meditation, a state of passive concentration occurs, which is sometimes called the alpha state, because at this time the brain generates predominantly alpha waves, just like before falling asleep.

Meditation reduces the activity of the sympathetic nervous system, helps reduce anxiety and relaxation. At the same time, the heart rate and breathing slow down, the need for oxygen decreases, the pattern of brain tension changes, and the reaction to a stressful situation is balanced.

There are many ways to meditate. You can read about them in books that have been published in large numbers lately. Meditation techniques are taught under the guidance of an instructor, in special courses.

Autogenic training

Autogenic training (AT) as an independent method of psychotherapy was proposed by Schulze in 1932. AT combines several techniques, in particular the visualization method.

AT includes a series of exercises through which a person consciously controls the functions of the body. You can master this technique under the guidance of a doctor.

Muscle relaxation achieved with AT affects the functions of the central and peripheral nervous systems, stimulates the reserve capabilities of the cerebral cortex, and increases the level of voluntary regulation of various body systems.

During relaxation, blood pressure decreases slightly, the heart rate slows down, breathing becomes rare and shallow, and peripheral vasodilation decreases - the so-called “relaxation response.”

Self-regulation of emotional and vegetative functions achieved with the help of AT, optimization of the state of rest and activity, increasing the ability to realize the psychophysiological reserves of the body allow this method to be used in clinical practice to enhance behavioral therapy, in particular for children with ADHD.

Hyperactive children are often tense and internally withdrawn, so relaxation exercises must be included in the correction program. This helps them relax, reduces psychological discomfort in unfamiliar situations, and helps them cope with various tasks more successfully.

Experience has shown that the use of autogenic training for ADHD helps reduce motor disinhibition, emotional excitability, improves spatial coordination, motor control, and enhances concentration.

Currently, there are a number of modifications of autogenic training according to Schulze. As an example, we will give two methods - a model of relaxation training for children 4–9 years old and psychomuscular training for children 8–12 years old, proposed by psychotherapist A.V. Alekseev.

The relaxation training model is a modified AT model specifically for children, used for adults. It can be used both in preschool and school educational institutions, and at home.

Teaching children to relax their muscles will help them relieve general tension.

Relaxation training can be carried out during individual and group psychological work, in gyms or in a regular classroom. Once children learn to relax, they will be able to do it on their own (without a teacher), which will increase their overall self-control. Successful mastery of relaxation techniques (like any success) can also increase their self-esteem.

To teach children to relax different muscle groups, it is not necessary that they know where and how these muscles are located. It is necessary to use children's imagination: include certain images in the instructions so that, when reproducing them, children automatically activate certain muscles. The use of fantasy images also helps to attract and maintain children's interest.

It should be noted that although children agree to learn how to relax, they do not want to practice this under the supervision of teachers. Fortunately, some muscle groups can be trained quite quietly. Children can do exercises in class and relax without attracting attention from others.

Of all the psychotherapeutic techniques, autogenic training is the most accessible to master and can be used independently. It has no contraindications for children with attention deficit hyperactivity disorder.

Hypnosis and self-hypnosis

Hypnosis is indicated for a number of neuropsychiatric diseases, including attention deficit hyperactivity disorder.

The literature provides a lot of data on complications during pop hypnosis sessions, in particular in 1981, Kleinhouse and Beran described the case of a teenage girl who felt “unwell” after a session of mass pop hypnosis. At home, her tongue sunk into her throat and she began to choke. In the hospital where she was hospitalized, she fell into a state of stupor, did not answer questions, did not distinguish between objects and people. There was urinary retention. Clinical and laboratory examinations revealed no abnormalities. The variety hypnotist who was called was unable to provide effective assistance. She was in this state for a week.

An attempt was made to put her into a hypnotic state by a psychiatrist well versed in hypnosis. Her condition improved after that, and she returned to school. However, three months later she had a relapse of the disease. It took 6 months of weekly sessions to get her back to normal. It should be said that earlier, before the variety hypnosis session, the girl had not observed any disturbances.

No such cases were observed during hypnosis sessions in a clinical setting by professional hypnotherapists.

All risk factors for complications of hypnosis can be divided into three groups: risk factors on the part of the patient, on the part of the hypnotherapist, and on the part of the environment.

To avoid complications on the part of the patient, before hypnotherapy, it is necessary to carefully select patients for treatment, find out the anamnestic data, previous diseases, as well as the mental state of the patient at the time of treatment and obtain his consent to conduct a hypnosis session. Risk factors on the part of the hypnotherapist include lack of knowledge, training, abilities, experience, and personal characteristics (alcohol, drug addiction, various addictions) can also influence.

The environment where hypnosis is performed should provide physical comfort and emotional support to the patient.

Complications during a session can be avoided if the hypnotherapist avoids all of the above risk factors.

Most psychotherapists believe that all types of hypnosis are nothing more than self-hypnosis. Self-hypnosis has been proven to have a beneficial effect on any person.

The use of the guided imagination method to achieve a state of self-hypnosis can be used by the child’s parents under the guidance of a hypnotherapist. An excellent guide to this technique is the book Self-Hypnosis by Brian M. Alman and Peter T. Lambrou.

We have described many techniques that can be used to correct attention deficit hyperactivity disorder. As a rule, these children have a variety of disorders, so in each case it is necessary to use a whole range of psychotherapeutic and pedagogical techniques, and in the case of a severe form of the disease, medications.

It must be emphasized that improvement in the child’s behavior will not appear immediately, however, with constant classes and following the recommendations, the efforts of parents and teachers will be rewarded.

3. E experimental study of mental processes in children with ADHD and with normal development

The experimental work was aimed at solving the following problems:

1. Select diagnostic tools.

2. To identify the level of development of cognitive processes in children with ADHD in comparison with the norm of development.

Stages of implementation of experimental research.

1. Examination of children with ADHD in order to identify the level of development of cognitive processes.

2. Examination of children with normal development, in order to identify the level of development of cognitive processes.

3. Comparative analysis of the obtained data.

The study was carried out in the compensating type MDOU No. 204 “Zvukovichok” and in the MDOU No. 2 “Beryozka” in the Talmensky district of the Altai Territory from December 2007 to May 2008.

The experimental group consisted of pupils of compensating type MDOU No. 204 “Zvukovichok”, consisting of 10 people; children from MDOU No. 2 “Beryozka” r. n. Talmenka with a development norm of 10 people. For a study on this topic, a group of children of senior preschool age (6–7 years old) was selected. The direct examination included several stages:

1. Introducing the child into the examination situation, establishing emotional contact with him.

2. Reporting the content of tasks, presenting instructions.

3. Observation of the child in the process of his activities.

4. Drawing up an examination protocol and evaluating the results.

During the study, we used such basic diagnostic methods as conversation, observation, experiment, as well as the method of quantitative and qualitative analysis of the data obtained.

We used the conversation method to establish contact with children; determining how they understand the essence of tasks and questions and where they have difficulties; clarification of the content of completed tasks, as well as in the diagnostic aspect itself.

We used the observation method to monitor the behavior of children, their reactions to this or that influence; how they perform tasks, how they are treated.

Since children with ADHD have impaired attention, which in turn is combined with motor activity, when interpreting the results of the study, we used not only quantitative analysis, but also qualitative analysis, guided by the characteristics of mental development and self-awareness of both normal children and with ADHD.

Based on the characteristics of the object, subject and objectives of our research, we used the following diagnostic techniques.

3.1 Methods for diagnosing attention

The following set of techniques is intended for studying the attention of children, assessing such qualities of attention as productivity, stability, switchability and volume. At the end of the examination of the child using all four methods presented here related to attention, we derived a general, integral assessment of the level of development of the preschooler’s attention.

“Find and cross out” technique

The choice of this technique is due to the fact that the task contained in this technique is intended to determine the productivity and stability of attention. We showed the child Figure 1.

Figure 1. Matrices with figures for the task “Find and cross out”

It contains images of simple figures in random order: a mushroom, a house, a bucket, a ball, a flower, a flag. Before the start of the study, the child received instructions with the following content: “Now you and I will play this game: I will show you a picture on which many different objects familiar to you are drawn. When I say the word “begin,” along the lines of this drawing you will begin to look for and cross out the objects that I name. It is necessary to search and cross out the named objects until I say the word “stop”. At this time, you must stop and show me the image of the object that you saw last. This completes the task." In this technique, children worked for 2.5 minutes.

“Put icons” technique

The choice of this technique is due to the fact that the test task in this technique is intended to assess the switching and distribution of the child’s attention. Before starting the task, we showed the child Figure 2 and explained how to work with it.

Figure 2. Matrix for the “Put icons” technique

Instructions: “This work consists of putting in each of the squares, triangles, circles and diamonds the sign that is given at the top of the sample, i.e., respectively, a tick, a line, a plus or a dot.”

Children worked continuously, completing this task for two minutes, and the overall indicator of switching and distribution of attention of each child was determined by the formula:

where S is an indicator of switching and distribution of attention;

N – the number of geometric shapes viewed and marked with appropriate signs within two minutes;

n – the number of errors made during the task. Errors were considered to be incorrectly placed or missing signs, i.e. geometric shapes not marked with appropriate signs. The results of the study are reflected in the diagram for diagnosing the attention of children with ADHD and with normal development (see diagram 1).

“Remember and dot the dots” technique

The choice of this technique is due to the fact that with the help of this technique the child’s attention span is assessed. For this purpose, the stimulus material shown in Figure 3 was used.

Figure 3. Stimulus material for the task “Remember and dot the dots”

The sheet with dots was first cut into 8 small squares, which were then folded into a stack so that at the top there was a square with two dots, and at the bottom - a square with nine dots (all the rest go from top to bottom in order with a successively increasing number of dots on them).

Before the experiment began, the child received the following instructions:

“Now we’ll play a game of attention with you. I will show you cards one by one with dots on them, and then you yourself will draw these dots in the empty cells in the places where you saw these dots on the cards.”

Next, the child was shown sequentially, for 1–2 seconds, each of eight cards with dots from top to bottom in a stack in turn, and after each next card he was asked to reproduce the dots he saw in an empty card in 15 seconds. This time was given to the child so that he could remember where the dots he saw were located and mark them on a blank card.

The results of the study are reflected in the diagram for diagnosing the attention of children with ADHD and with normal development (see diagram 1).

Diagram 1. Diagnosis of attention of children with ADHD and with normal development

Thus, from the diagram for diagnosing the attention of children with ADHD and with normal development, it is clear that: two children with normal development completed the task with a very high score; three children with normal development received a high score; four children with normal development and two children with ADHD showed average results; five children with ADHD and one child with normal development showed low results, and three children with ADHD showed very low results in completing tasks. Based on the conducted research, we can draw the following conclusions:

1) the level of quantitative indicators of voluntary attention in children with ADHD is significantly lower than in children with normal development;

2) differences were found in the manifestation of voluntary attention in children with ADHD depending on the modality of the stimulus (visual, auditory, motor): children with ADHD find it much more difficult to concentrate on completing a task under conditions of verbal rather than visual instructions, as a result of which in the first case there is a greater number of errors associated with gross disruption of differentiation;

3) a disorder of all properties of attention in children with ADHD as the most important factor in the organization of activity leads to an unformed or significant disruption of the structure of activity, while all the main links of activity suffer: a) the instructions were perceived by children inaccurately, fragmentarily; it was extremely difficult for them to focus their attention on analyzing the conditions of the task and searching for possible ways to complete it; b) children with ADHD performed tasks with errors, the nature of the errors and their distribution over time was qualitatively different from the norm; c) all types of control over their activities by children with ADHD are immature or significantly impaired;

4) a significant decrease in indicators in the main group is observed on the “Remember and Dot the Dots” test. A low result in completing a task indicates a decrease in the volume of short-term memory mediated by concentration. The findings are consistent with the “Put the Marks” results demonstrating instability of concentration in children with ADHD;

5) in the process of teaching children with ADHD the elementary technique of mastering voluntary attention, the help of a teacher or adult is required, in quantitative and qualitative terms, much more than the norm of development.

3.2 Methods for diagnosing thinking

Methodology “What’s superfluous here?”

Target: Assessment of figurative and logical thinking, level of development of analysis and generalization in a child.

Progress of the examination: Each time, trying to identify an extra object in a group, the child had to name out loud all the objects in the group in question one by one.

Working hours: Duration of work with the task is 3 minutes.

Instructions: “In each of these pictures, one of the 4 objects depicted is superfluous, inappropriate. Determine what item it is and why it is superfluous.”

Methodology "Classification"

Target : identifying the ability to classify, the ability to find the signs by which the classification is made.

Task text : look at these two pictures (the pictures for the task are indicated (Figure 4)). In one of these drawings you need to draw a squirrel. Think about what kind of picture you would draw her in. Draw a line with a pencil from the squirrel to this drawing.

Figure 4. Material for the “Classification” method

The results of the study are reflected in the diagram for diagnosing the thinking of children with ADHD and with normal development (see diagram 2).

Diagram 2. Diagnostics of the thinking of children with ADHD and with normal development

Thus, from the diagram for diagnosing the thinking of children with ADHD and with normal development, it is clear that: eight children with normal development and two children with ADHD completed the task with a very high score; two children with normal development and six children with ADHD received high scores; one child with ADHD performed averagely and one child with ADHD performed very poorly on the tasks. Based on the conducted research, we can draw the following conclusions:

1) the level of quantitative indicators of the development of thinking in children with ADHD is significantly lower than in children with normal development;

2) children with ADHD performed tasks with errors, the nature of the errors and their distribution over time was qualitatively different from the norm;

3) all types of control over their activities by children with ADHD are immature or significantly impaired;

4) data analysis shows that ADHD symptoms influence a decrease in test performance in all parameters, but proves that organic damage to intelligence is not observed, since the results vary within the average age indicators;

5) in the process of teaching children with ADHD the elementary technique of mastering logical thinking, the help of a teacher and an adult is required, in quantitative and qualitative terms, significantly greater than the norm of development.

3.3 Memory diagnostic methods

Methodology “Learn words”

Target: determination of the dynamics of the learning process.

Progress: The child received the task in several attempts to learn by heart and accurately reproduce a series consisting of 12 words: tree, doll, fork, flower, telephone, glass, bird, light bulb, picture, person, book.

Each child tried to reproduce the series after each successive listening. Each time we noted the number of words that the child was able to name. And they did this 6 times. Thus, the results of six attempts were obtained.

Methodology “Memorizing 10 pictures”

Target: The state of memory (mediated memorization), fatigue, and active attention is analyzed.

Object pictures measuring 10 x 15 cm were presented.

1 set: doll, chicken, scissors, book, butterfly, comb, drum, cow, bus, pear.

2 set: table, plane, shovel, cat, tram, sofa, key, goat, lamp, flower.

Instructions:

1. “I will show pictures, and you tell me what you see in them.” After 30 seconds: “Remember what you saw?”

2. “Now I will show you other pictures. Try to remember as many of them as possible so that you can repeat them to me later.”

The results of the study are reflected in the memory diagnostic diagram for children with ADHD and with normal development (see Diagram 3).

Methodology “How to patch a rug?”

We used this technique to determine the extent to which a child is able, while retaining images of what he saw in short-term and operational memory, to practically use them when solving visual problems. This technique used the pictures presented in Figure 5.

Figure 5. Pictures for the method “How to patch a rug?”

Before showing it to the child, we told him that this picture shows two rugs, as well as pieces of material that can be used to patch holes in the rugs, so that the patterns of the rug and the patch do not differ. In order to solve the problem, from several pieces of material presented in the lower part of the picture, you need to select the one that most closely matches the design of the rug.

The results of the study are reflected in the memory diagnostic diagram for children with ADHD and with normal development (see Diagram 3).

Diagram 3. Diagnostics of memory of children with ADHD and with normal development

Thus, from the diagram for diagnosing the memory of children with ADHD and with normal development, it is clear that: two children with normal development completed the task with a high score; seven children with normal development and two children with ADHD showed average results; six children with ADHD and one child with normal development showed low results, and two children with ADHD showed very low results on tasks. Based on the conducted research, we can draw the following conclusions:

1) In the main group, the value of indicators is lower than the value of indicators in the control group;

2) memory disorders of varying severity are observed when learning words. More than half of the children with ADHD violated the sequence of presentation of words, confused and rearranged words, and replaced words with similar or even inappropriate words. After a certain period of time, about 75% of children were unable to reproduce the words they had learned;

3) this decrease allows us to judge the low volume of long-term memory, which is associated with a low level of the regulatory process, a narrowing of the attention span, involuntary switching due to impulsivity and hyperactivity, lack of control over the quality of activity performance and low interest of children with ADHD;

4) analysis of the data presented in Diagram 3 showed that the test results in the main group were significantly - 2 times - lower than in the control group. When studying short-term memory, the functional state, attentional activity, exhaustion and dynamics of mnestic activity were assessed. Test results indicate that immediate memory is impaired and short-term memory is reduced.

3.4 Methods for diagnosing perception

Methodology “What is missing from these pictures?”

The essence of this technique is that the child was offered a series of drawings presented in Figure 5.

Figure 5. Material for the method “What is missing from these pictures?”

Each of the pictures in this series is missing some essential detail. The child received the task: “ Identify and name the missing part.”

Using a stopwatch, we recorded the time the child spent completing the entire task. The work time was assessed in points, which then served as the basis for a conclusion about the level of development of perception of a child with ADHD and with the norm of development.

Method “Find out who it is”

Before applying this technique, we explained to the child that he would be shown parts, fragments of a certain drawing, from which it would be necessary to determine the whole to which these parts belong, i.e. restore the whole drawing from a part or fragment.

A psychodiagnostic examination using this technique was carried out as follows. The child was shown Figure 6, in which all the fragments were covered with a piece of paper, with the exception of fragment “a”. The child was asked to use this fragment to say to which general drawing the depicted detail belongs. 10 seconds were allotted to solve this problem. If during this time the child was unable to correctly answer the question posed, then for the same time - 10 seconds. - he was shown the next, slightly more complete drawing “b”, and so on until the child finally guessed what was shown in this drawing.

Figure 6. Pictures for the “Find out who it is” technique

The total time spent by the child on solving the problem and the number of fragments of the drawing that he had to look through before making a final decision were taken into account.

The results of the study are reflected in the diagram for diagnosing the perception of children with ADHD and with normal development (see Diagram 4).

Methodology “What objects are hidden in the drawings?”

We explained to the child that he would be shown several contour drawings in which many objects known to him were “hidden,” as it were. Next, the child was presented with Figure 7 and asked to sequentially name the outlines of all the objects “hidden” in its three parts: 1, 2 and 3.

Figure 7. Pictures for the method “What objects are hidden in the pictures”

The task completion time was limited to one minute. If during this time the child was unable to completely complete the task, he was interrupted. If the child completed the task in less than 1 minute, then the time spent on completing the task was recorded.

If we saw that the child began to rush and prematurely, without finding all the objects, moved from one drawing to another, then we stopped the child and asked him to look in the previous drawing. It was allowed to move on to the next drawing only when all the objects in the previous drawing were found. The total number of all items “hidden” in Figures 7 was 14 items.

The results of the study are reflected in the diagram for diagnosing the perception of children with ADHD and with normal development (see Diagram 4).

Diagram 4. Diagnostics of the perception of children with ADHD and with normal development

Thus, from the diagnostic diagram of perception of children with ADHD and with normal development it is clear that: six children with normal development completed the task with a very high score; two children with normal development and one child with ADHD received a high score; two children with normal development and five children with ADHD showed average results; four children with ADHD performed poorly and two children with ADHD performed very poorly on the tasks. Based on the conducted research, we can draw the following conclusions:

1) test scores in the main group are significantly lower than in the control group;

2) a decrease in value in this series indicates a narrowing of perception, holistic perceptual activity, insufficient accuracy in carrying out mental operations of comparing different images and differentiating details;

3) the results of the study of perception in children with ADHD are also lower than in the control group. A decrease in indicators indicates the child’s lack of confidence in the ability to establish patterns depending on the organization of image elements.

General conclusions from the study of cognitive processes in children with ADHD in comparison with normal development

In general, an analysis of the tests performed by children with ADHD did not reveal severe disorders of higher mental functions. The most typical for the children examined were disorders of such cognitive functions as attention and memory, as well as insufficient development of the functions of organizing programming and control.

Compared to children with normal development, children with ADHD lagged behind in the time it took to complete tasks. This is due to impaired attention, increased distractibility, and rapid fatigue. Children are somatically well, so this factor is not taken into account.

Compared to children with normal development, children with ADHD made many mistakes. The children were distracted by any noise, in a hurry, trying to complete the task faster in order to return to the group and continue playing with other children. The number of mistakes made increases towards the middle and end of the task, which is due to excessive fatigue of the children, and sometimes – reluctance to complete the task.

Amount of help offered

Basically, a demonstration of completing tasks was required. Sometimes it was necessary to stimulate the children's actions. Two children had to demonstrate the final result in order to update the visual image. Children with ADHD accepted help well. Unlike children with ADHD, children with normal development did not require assistance in completing tasks. They understood the instructions without even listening to the end; a demonstration was not required at all. It can be concluded that the gap between the help offered to children with ADHD is significant.

Thus, for the advancement of a child with ADHD in general development, for his assimilation of knowledge, abilities and skills, for their systematization and practical application, it is important not ordinary, but specially organized training and education.

3.5 Child Emotional Rating Scale

To study the emotional manifestations of children with normal development and children with ADHD, we developed the “Child Emotional Manifestations Scale.” The study was carried out according to the type of survey of preschool teachers who had been in contact with the children of our experimental groups for a long time. The creation of the scale was based on observation of the behavior of a child in a kindergarten group. The teachers presented the results of observations on a rating scale, where the child’s emotional manifestations were listed vertically, and the degree of expression of each of them was noted horizontally.

Target: identifying signs of mental stress and neurotic tendencies in preschool children with normal development and children with ADHD.

We paid special attention to such emotional manifestations of children as hypersensitivity, excitability, capriciousness, timidity, tearfulness, stubbornness, malice, cheerfulness, envy, jealousy, touchiness, cruelty, affectionateness, sympathy, conceit, aggressiveness, impatience.

Analyzing the results obtained, we concluded that in children with ADHD, compared with normally developing peers, such emotional manifestations as excitability, stubbornness, cheerfulness, cruelty, and impatience predominate. And such manifestations as hypersensitivity, fearfulness, jealousy, affection, and sympathy are characteristic of children with ADHD to a lesser extent. (Appendix 4)

In a home correction program for children with attention deficit hyperactivity disorder, the behavioral aspect should prevail:

1. Changing the behavior of an adult and his attitude towards the child:

– show sufficient firmness and consistency in upbringing;

– remember that excessive talkativeness, mobility and indiscipline are not intentional;

– control the child’s behavior without imposing strict rules on him;

– do not give your child categorical instructions, avoid the words “no” and “impossible”;

– build relationships with your child on mutual understanding and trust;

– avoid, on the one hand, excessive softness, and, on the other, excessive demands on the child;

– react to the child’s actions in an unexpected way (make a joke, repeat the child’s actions, take a photo of him, leave him alone in the room, etc.);

– repeat your request in the same words many times;

– do not insist that the child apologize for the offense;

– listen to what the child wants to say;

– Use visual stimulation to reinforce verbal instructions.

2. Changing the psychological microclimate in the family:

– give the child enough attention;

– spend leisure time with the whole family;

– do not allow quarrels in the presence of a child.

3. Organization of the daily routine and place for classes:

– establish a solid daily routine for the child and all family members;

– show your child more often how best to complete a task without distractions;

– reduce the influence of distractions while the child is performing a task;

– protect hyperactive children from prolonged use of the computer and watching television;

– avoid large crowds of people whenever possible;

– remember that overwork contributes to a decrease in self-control and an increase in hyperactivity;

– organize support groups consisting of parents with children with similar problems.

4. Special behavioral program:

– come up with a flexible system of rewards for a task well completed and punishments for bad behavior. You can use a point or sign system, keep a self-control diary;

– do not resort to physical punishment! If there is a need to resort to punishment, then it is advisable to use a quiet sitting in a certain place after committing an act;

– Praise your child more often. The threshold of sensitivity to negative stimuli is very low, so hyperactive children do not perceive reprimands and punishments, but are sensitive to rewards;

– make a list of the child’s responsibilities and hang it on the wall, sign an agreement for certain types of work;

– educate children in anger and aggression management skills;

– do not try to prevent the consequences of a child’s forgetfulness;

– gradually expand responsibilities, having previously discussed them with the child;

– do not allow the task to be postponed until another time;

– do not give your child instructions that do not correspond to his level of development, age and abilities;

– help your child begin the task, as this is the most difficult stage;

– do not give several instructions at the same time. The task given to a child with impaired attention should not have a complex structure and consist of several links;

– explain to the hyperactive child about his problems and teach him to cope with them.

Remember that verbal means of persuasion, appeals, and conversations are rarely effective, since a hyperactive child is not yet ready for this form of work.

Remember that for a child with attention deficit hyperactivity disorder, the most effective means of persuasion “through the body” are:

– deprivation of pleasure, delicacy, privileges;

– ban on pleasant activities, telephone conversations;

– reception of “off time” (isolation, corner, penalty box, house arrest, early departure to bed);

– an ink dot on the child’s wrist (“black mark”), which can be exchanged for a 10-minute sitting on the “penalty bench”;

– holding, or simple holding in an “iron embrace”;

– extraordinary duty in the kitchen, etc.

Do not rush to interfere with the actions of a hyperactive child with directive instructions, prohibitions and reprimands. Yu.S. Shevchenko gives the following examples: - if the parents of a primary school student are worried that every morning their child wakes up reluctantly, dresses slowly and is in no hurry to go to kindergarten, then you should not give him endless verbal instructions, rush him and scold him. You can give him the opportunity to learn a “life lesson.” Having been really late for kindergarten, and having gained experience in explaining things to the teacher, the child will be more responsible about getting ready in the morning;

– if a child breaks a neighbor’s glass with a soccer ball, then there is no need to rush to take responsibility for solving the problem. Let the child explain himself to the neighbor and offer to atone for his guilt, for example, by washing his car every day for a week. Next time, when choosing a place to play football, the child will know that only he himself is responsible for the decision he makes;

– if money has disappeared from the family, there is no useless demand for confession of theft. You should remove the money and not leave it as a provocation. And the family will be forced to deprive themselves of delicacies, entertainment and promised purchases; this will certainly have an educational effect;

– if a child has abandoned his thing and cannot find it, then you should not rush to his aid. Let him search. Next time he will be more responsible about his things.

Remember that following punishment, positive emotional reinforcement and signs of “acceptance” are necessary. In correcting a child’s behavior, the “positive model” technique plays an important role, which consists in constantly encouraging the child’s desired behavior and ignoring the undesirable. A necessary condition for success is that parents understand their child’s problems.

Remember that it is impossible to make hyperactivity, impulsivity and inattention disappear in a few months or even in a few years. Signs of hyperactivity disappear as people get older, but impulsivity and attention deficits may persist into adulthood.

Remember that attention deficit hyperactivity disorder is a pathology that requires timely diagnosis and comprehensive correction: psychological, medical, pedagogical. Successful rehabilitation is possible if it is carried out between the ages of 5 and 10 years.

The school program for correction of hyperactive children should rely on cognitive correction to help children cope with learning difficulties:

1. Changing the environment:

– study the neuropsychological characteristics of children with attention deficit hyperactivity disorder;

– work with a hyperactive child individually. A hyperactive child should always be in front of the teacher, in the center of the class, right next to the blackboard;

– the optimal place in the classroom for a hyperactive child is the first desk opposite the teacher’s desk or in the middle row;

– change the lesson mode to include physical education minutes;

– allow a hyperactive child to get up and walk to the back of the class every 20 minutes;

– give your child the opportunity to quickly turn to you for help in case of difficulty;

– direct the energy of hyperactive children in a useful direction: wash the board, distribute notebooks, etc.

2. Creating positive motivation for success:

– introduce a sign grading system;

– praise the child more often;

– the lesson schedule must be constant;

– avoid over or underestimating demands on a student with ADHD;

– introduce problem-based learning;

– use elements of games and competition in the lesson;

– give tasks in accordance with the child’s abilities;

– break large tasks into successive parts, controlling each of them;

– create situations in which a hyperactive child can show his strengths and become an expert in the class in certain areas of knowledge;

– teach your child to compensate for impaired functions at the expense of intact ones;

– ignore negative actions and encourage positive ones;

– build the learning process on positive emotions;

– remember that you need to negotiate with your child, and not try to break him!

3. Correction of negative behaviors:

– contribute to the elimination of aggression;

– teach necessary social norms and communication skills;

– regulate his relationships with classmates.

4. Managing expectations:

– explain to parents and others that positive changes will not come as quickly as we would like;

– explain to parents and others that improvement of the child’s condition depends not only on special treatment and correction, but also on a calm and consistent attitude.

Remember that touch is a powerful stimulant for shaping behavior and developing learning skills. Touch helps anchor a positive experience. An elementary school teacher in Canada conducted a touch experiment in his classroom, where the teacher would randomly meet these students one day and encourage them to touch their shoulder, saying in a friendly manner, “I approve of you.” When they broke the rules of conduct, the teachers ignored it as if they didn't notice. In all cases, within the first two weeks, all students began to behave well and turn in their homework books.

Remember that hyperactivity is not a behavioral problem, not the result of poor upbringing, but a medical and neuropsychological diagnosis that can only be made based on the results of special diagnostics. The problem of hyperactivity cannot be solved by willful efforts, authoritarian instructions and beliefs. A hyperactive child has neurophysiological problems that he cannot cope with on his own. Disciplinary measures in the form of constant punishments, comments, shouts, lectures will not lead to an improvement in the child’s behavior, but rather will worsen it. Effective results in the correction of attention deficit hyperactivity disorder are achieved with an optimal combination of medicinal and non-medicinal methods, which include psychological and neuropsychological correction programs.

Conclusion

The problem of the prevalence of attention deficit hyperactivity disorder is relevant not only because it is one of the modern characteristics of the health status of the child’s body. This is the most important psychological problem of the civilized world, evidence of which is that:

– firstly, children with the syndrome do not master the school curriculum well;

– secondly, they do not obey generally accepted rules of behavior and often take the criminal path. More than 80% of the criminal population are people with ADHD;

– thirdly, they are 3 times more likely to experience various accidents, in particular, they are 7 times more likely to get into car accidents;

– fourthly, the likelihood of becoming a drug addict or alcoholic in these children is 5–6 times higher than in children with normal ontogenesis;

– fifthly, attention disorders affect from 5% to 30% of all school-age children, i.e. in each class of a regular school there are 2-3 people - children with attention disorders and hyperactivity.

In the course of an experimental study, we confirmed the hypothesis and proved that the level of intelligence of children with ADHD does not correspond to the age norm. A psychological examination of children made it possible to determine the level of intellectual development of children with ADHD, and in addition, possible disturbances in perception, memory, attention, and the emotional-volitional sphere. Knowledge of the specific features of the mental development of children with ADHD allows us to develop a model of correctional assistance for such children, since preschool age is an important period in the development of a child’s personality, when the compensatory capabilities of the brain are great, which helps prevent the formation of persistent pathological manifestations. This period is important in terms of preventing the development of behavior disorders, as well as maladaptive school syndrome. In this regard, the search for criteria for the diagnosis and correction of ADHD in preschool age is extremely important for the timely identification and correction of deviations, stimulation of the development of immature higher brain functions. At the same time, the bulk of the work concerns the study of school-age children, when learning and behavioral difficulties come to the fore. In view of this, the issues of organizing psychological and medical assistance to families of children with ADHD, aimed at early and preschool age, are becoming of great practical importance today.

List of used literature

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Applications

Annex 1

List of the experimental group of children from MDOU No. 204 “Zvukovichok” of compensatory type 2001–2002. birth

1. Balakirov Roman

2. Bezuglov Mikhail

3. Emelianenko Maxim

4. Zhivlyakova Maria

5. Zinchenko Daria

6. Otroshchenko Danil

7. Panova Angela

8. Foltz Yakov

9. Kharlamov Dmitry

10. Shlyapnikov Dmitry

List of the control group of children from MDOU No. 2 “Berezka” r. Talmenka village, Altai Territory 2001–2002 birth

1. Batsalova Anastasia

2. Glebova Alena

3. Kuleva Julia

4. Parshin Konstantin

5. Pushkarev Anton

6. Rassolova Lisa

7. Solovyova Alisa

8. Smirnova Anastasia

9. Trunova Marina

10. Shadrina Yulia

Appendix 2

Point system for evaluating results

Quantitative assessment of the results was carried out using a point system, as a result of which we made conclusions about the cognitive development of children.

Conclusions about the level of development:

10 points – very high level

8–9 points – high level

6–7 points – average level

4–5 points – low level

0–3 points – very low level

Appendix 3

Children's drawings

As an additional method for comparative study of the mental processes of children with ADHD and children with normal development, we used the “Person Drawing” test.

Based on the test, the following conclusions were drawn:

1. The drawings of children with ADHD have distinct distinctive features.

2. Children's drawings are primitive and disproportionate.

3. The lines of the drawing are mutually uncoordinated and are not clearly connected to each other.

Pyloric stenosis is a problem of the stomach being unable to take in much food.

Reciprocal - cross, multidirectional.

Dyslexia is a partial disorder of the process of mastering reading, manifested in numerous repeated errors of a persistent nature and caused by the immaturity of the mental functions involved in the process of mastering reading.

Dysgraphia is a partial impairment of writing skills due to focal damage, underdevelopment or dysfunction of the cerebral cortex.

Dyscalculia is a disorder in the formation of numeracy skills due to focal lesions, underdevelopment or dysfunction of the cerebral cortex.

Suggestive therapy - hypnosis.

Vasodilation - dilation of blood vessels

Relapse – return of the disease, exacerbation of the disease.

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychoneurological disorders in children. Its diagnosis is based on the international criteria of ICD-10 and DSM-IV-TR, but must also take into account the age-related dynamics of ADHD and the characteristics of its manifestations in preschool, primary school and adolescence. Additional difficulties in family, school and social adaptation in ADHD are often associated with comorbid disorders, which are observed in at least 70% of patients. The neuropsychological mechanisms of ADHD are considered from the standpoint of insufficient development of executive functions provided by the prefrontal parts of the brain. ADHD is based on neurobiological factors: genetic mechanisms and early organic brain damage. The role of micronutrient deficiencies, in particular magnesium, is being studied, which may have an additional effect on neurotransmitter balance and the manifestation of ADHD symptoms. Treatment of ADHD should be based on an expanded therapeutic approach that involves addressing the patient’s social and emotional needs and assessing, during follow-up, not only the reduction of the main symptoms of ADHD, but also functional outcomes and quality of life indicators. Drug therapy for ADHD includes atomoxetine hydrochloride (Strattera), nootropic drugs, neurometabolic drugs, including Magne B 6. Treatment for ADHD must be comprehensive and long-lasting.

Keywords: attention deficit hyperactivity disorder, children, diagnosis, treatment, magnesium, pyridoxine, Magne B 6

Attention deficit hyperactivity disorder: diagnosis, pathogenesis, principles of treatment

N.N.Zavadenko
N.I.Pirogov Russian National Research Medical University, Moscow

Attention deficit hyperactivity disorder (ADHD) is one of the common psychoneurological disorders in children. Its diagnosis is based on the international criteria ICD-10 and DSM-IV-TR, but also should take into account the age-related dynamics of ADHD and specificities of its manifestations during the preschool, junior school and adolescent periods. Additional difficulties of intrafamilial, school and social adaptation in ADHD are often related to comorbid disorders, which are found in not less than 70% of patients. The neuropsychological mechanisms of ADHD are viewed from the positions of insufficient formation of the controlling functions that are ensured by the prefrontal regions of the brain. ADHD is based on neurobiological factors, such as genetic mechanisms and early organic damage of the brain. The role of micronutrient deficiency has been studied, in particular, of magnesium that might have an additional effect on the neuromediatory balance and manifestation of ADHD symptoms. Treatment of ADHD should be based on a comprehensive therapeutic approach that presupposes taking into consideration the social and emotional needs of a patient and assessing, by dynamic observation, not only reduction of the major ADHD symptoms but also the functional outcomes, the indicators of the quality of life. Drug therapy for ADHD includes atomoxetine hydrochloride (strattera), nootropic drugs, and neurometabolic medications, such as Magne B 6. ADHD therapy should be complex and sufficiently long-term.

Key words: attention deficit hyperactivity disorder, children, diagnosis, treatment, magnesium. pyridoxine, Magne B 6

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychoneurological disorders in childhood. ADHD is widely represented in the pediatric population. Its prevalence ranges from 2 to 12% (average 3-7%) and is more common in boys than girls (average ratio 3:1). ADHD can occur alone or in combination with other emotional and behavioral disorders, having a negative impact on learning and social adaptation.

The first manifestations of ADHD are usually noted from 3-4 years of age. But when a child gets older and enters school, he faces additional difficulties, since the beginning of schooling places new, higher demands on the child’s personality and intellectual capabilities. It is during the school years that attention deficits become apparent, as well as difficulties in mastering school skills and poor academic performance, self-doubt and low self-esteem. In addition to the fact that children with ADHD behave poorly and do poorly at school, as they get older, they may be at risk for developing deviant and antisocial behavior, alcoholism, and drug addiction. Therefore, it is important for professionals to recognize the early manifestations of ADHD and be aware of treatment options.

Symptoms of ADHD in a child may be the reason for an initial visit to pediatricians, as well as speech therapists, speech pathologists, and psychologists. Often, teachers in preschool and school educational institutions first pay attention to the symptoms of ADHD.

Diagnosis criteria. Diagnosis of ADHD is based on international criteria, which include lists of the most characteristic and clearly visible signs of this disorder. The International Classification of Diseases, 10th Revision (ICD-10) and the American Psychiatric Association classification DSM-IV-TR approach the criteria for diagnosing ADHD from similar positions (table). In ICD-10, ADHD is classified as a hyperkinetic disorder (category F90) in the section “Behavioral and emotional disorders with onset in childhood and adolescence,” and in DSM-IV-TR, ADHD is presented in category 314 in the section “Disorders first diagnosed in infancy.” , childhood or adolescence." Mandatory characteristics of ADHD also include:

Duration: symptoms persist for at least 6 months;
constancy, distribution to all spheres of life: adaptation disorders are observed in two or more types of environment;
severity of violations: significant impairments in learning, social contacts, professional activities;
other mental disorders are excluded: symptoms cannot be associated exclusively with the course of another disease.

The DSM-IV-TR classification defines ADHD as a primary disorder. At the same time, depending on the prevailing symptoms, the following forms of ADHD are distinguished:

combined (combined) form - all three groups of symptoms are present (50-75%);
ADHD with predominant attention disorders (20-30%);
ADHD with a predominance of hyperactivity and impulsivity (about 15%).

In ICD-10, which is used in the Russian Federation, the diagnosis of “hyperkinetic disorder” is approximately equivalent to the combined form of ADHD according to DSM-IV-TR. To make a diagnosis according to ICD-10, all three groups of symptoms must be confirmed, including at least 6 manifestations of inattention, at least 3 of hyperactivity, and at least 1 of impulsivity. Thus, the ICD-10 diagnostic criteria for ADHD are more stringent than those in the DSM-IV-TR and only identify the combined form of ADHD.

Currently, the diagnosis of ADHD is based on clinical criteria. To confirm ADHD, there are no special criteria or tests based on the use of modern psychological, neurophysiological, biochemical, molecular genetic, neuroradiological and other methods. The diagnosis of ADHD is made by a doctor, but teachers and psychologists should also be well acquainted with the diagnostic criteria for ADHD, especially since to confirm this diagnosis it is important to obtain reliable information about the child’s behavior not only at home, but also at school or preschool.

Table. Main manifestations of ADHD according to ICD-10

Symptom groups	Characteristic symptoms of ADHD

1. Attention disorders	Does not pay attention to details and makes many mistakes. Has difficulty maintaining attention when completing school and other tasks. Does not listen to speech addressed to him. Cannot follow instructions and complete a task. Unable to independently plan and organize tasks. Avoids activities that require prolonged mental stress. Often loses his things. Easily distracted. Shows forgetfulness.
2a. Hyperactivity	Often makes restless movements with his arms and legs, fidgets in place. Cannot sit still when needed. Often runs around or climbs somewhere when it is inappropriate. Can't play quietly and calmly. Excessive aimless motor activity is persistent and is not affected by the rules and conditions of the situation.
2b. Impulsiveness	Answers questions without listening to the end and without thinking. Can't wait his turn. Disturbs other people, interrupts them. Talkative, unrestrained in speech.

Differential diagnosis. In childhood, conditions that mimic ADHD are quite common: 15-20% of children periodically exhibit forms of behavior that are externally similar to ADHD. In this regard, ADHD must be distinguished from a wide range of conditions that are similar to it only in external manifestations, but differ significantly both in reasons and methods of correction. These include:

individual characteristics of personality and temperament: the characteristics of the behavior of active children do not exceed the boundaries of the age norm, the level of development of higher mental functions is good;
anxiety disorders: the child’s behavioral characteristics are associated with the action of traumatic factors;
consequences of traumatic brain injury, neuroinfection, intoxication;
asthenic syndrome in somatic diseases;
specific disorders of the development of school skills: dyslexia, dysgraphia, dyscalculia;
endocrine diseases (thyroid pathology, diabetes mellitus);
sensorineural hearing loss;
epilepsy (absence forms; symptomatic, locally caused forms; side effects of anti-epileptic therapy);
hereditary syndromes: Tourette, Williams, Smith-Magenis, Beckwith-Wiedemann, fragile X;
mental disorders: autism, affective (mood) disorders, mental retardation, schizophrenia.

In addition, the diagnosis of ADHD should be based on the unique age-related dynamics of this condition. ADHD symptoms have their own characteristics in preschool, primary school and adolescence.

Preschool age . Between the ages of 3 and 7 years, hyperactivity and impulsivity usually begin to appear. Hyperactivity is characterized by the fact that the child is in constant motion, cannot sit still during classes for even a short time, is too talkative and asks an endless number of questions. Impulsivity is expressed in the fact that he acts without thinking, cannot wait for his turn, does not feel restrictions in interpersonal communication, interfering in conversations and often interrupting others. Such children are often characterized as having little behavior or being too temperamental. They are extremely impatient, argue, make noise, shout, which often leads them to outbursts of severe irritation. Impulsivity may be accompanied by “fearlessness,” causing the child to endanger himself (increased risk of injury) or others. During games, energy overflows, and therefore the games themselves become destructive. Children are sloppy, often throw and break things or toys, are disobedient, do not obey the demands of adults, and can be aggressive. Many hyperactive children lag behind their peers in speech development.

School age . After entering school, the problems of children with ADHD increase significantly. The learning demands are such that a child with ADHD is unable to fully meet them. Because his behavior does not correspond to the age norm, he fails to achieve results in school that correspond to his abilities (the general level of intellectual development in children with ADHD corresponds to the age range). During lessons, it is difficult for them to cope with the proposed tasks, since they experience difficulties in organizing the work and bringing it to the end, forget the conditions of the task as they complete it, poorly absorb the educational materials and cannot apply them correctly. They quickly turn off from the process of doing work, even if they have everything necessary for this, do not pay attention to details, show forgetfulness, do not follow the teacher’s instructions, and do not switch well when the conditions of the task change or a new one is given. They cannot cope with homework on their own. Compared with peers, difficulties in developing writing, reading, and counting skills are much more common.

Problems in relationships with others, including peers, teachers, parents, and siblings, are constantly encountered in children with ADHD. Since all manifestations of ADHD are characterized by significant fluctuations over different periods of time and in different situations, the child’s behavior is unpredictable. Hot temper, cockiness, oppositional and aggressive behavior are often observed. As a result, he cannot play for a long time, communicate successfully and establish friendly relationships with peers. In a group, he serves as a source of constant anxiety: he makes noise without thinking, takes other people’s things, and disturbs others. All this leads to conflicts, and the child becomes unwanted and rejected in the team. When faced with such attitudes, children with ADHD often consciously choose to play the role of class jester, hoping to improve relationships with their peers. A child with ADHD not only studies poorly on his own, but often “disrupts” lessons, interferes with the work of the class, and therefore is often called to the principal’s office. In general, his behavior creates the impression of “immaturity”, inappropriate for his age, that is, he is infantile. Usually only younger children or peers with similar behavioral problems are ready to communicate with him. Gradually, children with ADHD develop low self-esteem.

At home, children with ADHD typically suffer from constant comparisons with siblings who behave well and do better academically. Parents are annoyed by the fact that they are restless, intrusive, emotionally labile, undisciplined, and disobedient. At home, the child is unable to responsibly carry out daily tasks, does not help parents, and is sloppy. At the same time, comments and punishments do not give the desired results. According to the parents, “He is always unlucky,” “Something always happens to him,” that is, there is an increased risk of injuries and accidents.

Adolescence . It has been established that in adolescence, severe symptoms of attention disorders and impulsivity continue to be observed in at least 50-80% of children with ADHD. At the same time, hyperactivity in adolescents with ADHD decreases significantly and is replaced by fussiness and a feeling of internal restlessness. They are characterized by lack of independence, irresponsibility, difficulties in organizing and completing assignments and especially long-term work, which they are often unable to cope with without outside help. Academic performance at school often deteriorates, since they cannot effectively plan their work and distribute it over time, and they put off doing necessary things from day to day.

Difficulties in relationships in the family and school, and behavioral disorders are increasing. Many adolescents with ADHD are characterized by reckless behavior involving unjustified risks, difficulties in following rules of conduct, disobedience to social norms and laws, and failure to comply with the demands of adults - not only parents and teachers, but also officials, such as school administrators or police officers. At the same time, they are characterized by weak psycho-emotional stability in the event of failures, self-doubt, and low self-esteem. They are overly sensitive to teasing and ridicule from peers who think they are stupid. Others continue to characterize the behavior of adolescents with ADHD as immature and inappropriate for their age. In their daily lives, they neglect the necessary safety measures, which increases the risk of injuries and accidents.

Teenagers with ADHD are prone to becoming involved in teenage gangs that commit various offenses, and they may develop a craving for alcohol and drug use. But in these cases, they, as a rule, turn out to be followers, submitting to the will of peers or people older than themselves who are stronger in character and without thinking about the possible consequences of their actions.

Disorders associated with ADHD (comorbid disorders). Additional difficulties in family, school and social adaptation in children with ADHD may be associated with the formation of concomitant disorders that develop against the background of ADHD as the underlying disease in at least 70% of patients. The presence of comorbid disorders can lead to aggravation of the clinical manifestations of ADHD, worsening long-term prognosis and reduced effectiveness of primary therapy for ADHD. Concomitant behavioral disorders and emotional disorders associated with ADHD are considered unfavorable prognostic factors for long-term, even chronic, course of ADHD.

Comorbid disorders in ADHD are represented by the following groups: externalized (oppositional defiant disorder, conduct disorder), internalized (anxiety disorders, mood disorders), cognitive (speech development disorders, specific learning difficulties - dyslexia, dysgraphia, dyscalculia), motor (static-locomotor deficiency, developmental dyspraxia, tics). Other accompanying ADHD disorders may include sleep disorders (parasomnias), enuresis, and encopresis.

Thus, problems in learning, behavior and emotional health may be associated both with the direct influence of ADHD and with comorbid disorders, which should be promptly diagnosed and considered as indications for additional appropriate treatment.

Pathogenesis of ADHD. The formation of ADHD is based on neurobiological factors: genetic mechanisms and early organic damage to the central nervous system (CNS), which can be combined with each other. They are the ones who determine changes in the central nervous system, disorders of higher mental functions and behavior that correspond to the picture of ADHD. The results of modern research indicate the involvement of the “associative cortex-basal ganglia-thalamus-cerebellum-prefrontal cortex” system in the pathogenetic mechanisms of ADHD, in which the coordinated functioning of all structures ensures the control of attention and the organization of behavior.

In many cases, additional influence on children with ADHD is exerted by negative socio-psychological factors (primarily intra-family), which in themselves do not cause the development of ADHD, but always contribute to an increase in the child’s symptoms and adaptation difficulties.

Genetic mechanisms. The genes that determine predisposition to the development of ADHD (the role of some of them in the pathogenesis of ADHD has been confirmed, while others are considered candidates) include genes that regulate the exchange of neurotransmitters in the brain, in particular dopamine and norepinephrine. Dysfunction of the brain's neurotransmitter systems plays an important role in the pathogenesis of ADHD. In this case, the main significance is the disruption of synaptic transmission processes, which entail disconnection, interruption of connections between the frontal lobes and subcortical formations and, as a consequence, the development of ADHD symptoms. In favor of disturbances in neurotransmitter transmission systems as a primary link in the development of ADHD is evidenced by the fact that the mechanisms of action of drugs that are most effective in the treatment of ADHD are the activation of the release and inhibition of the reuptake of dopamine and norepinephrine in presynaptic nerve endings, which increases the bioavailability of neurotransmitters at the synapse level .

In modern concepts, attention deficit in children with ADHD is considered as a result of disturbances in the functioning of the posterior cerebral attention system, regulated by norepinephrine, while the disorders of behavioral inhibition and self-control characteristic of ADHD are considered as a failure of dopaminergic control over the flow of impulses to the forebrain attention system. The posterior cerebral system includes the superior parietal cortex, the superior colliculus, the thalamic cushion (the dominant role in this case belongs to the right hemisphere); this system receives dense noradrenergic innervation from the locus coeruleus (locus coeruleus). Norepinephrine suppresses spontaneous neuronal discharges, thereby preparing the posterior cerebral attention system, which is responsible for orienting to new stimuli, to work with them. Following this, attention mechanisms switch to the forebrain control system, which includes the prefrontal cortex and the anterior cingulate cortex. The susceptibility of these structures to incoming signals is modulated by dopaminergic innervation from the ventral tegmental nucleus of the midbrain. Dopamine selectively regulates and limits excitatory impulses to the prefrontal cortex and cingulate cortex, ensuring a reduction in excessive neuronal activity.

Attention deficit hyperactivity disorder is considered a polygenic disorder, in which multiple simultaneous disturbances in the metabolic processes of dopamine and/or norepinephrine are caused by the influence of several genes, overriding the protective effect of compensatory mechanisms. The effects of genes that cause ADHD are additive, complementary. Thus, ADHD is considered as a polygenic pathology with complex and variable inheritance, and at the same time as a genetically heterogeneous condition.

Pre- and perinatal factors plays an important role in the pathogenesis of ADHD. A comparative analysis of anamnestic information in children with ADHD and their healthy peers showed that the formation of ADHD may be preceded by disturbances during pregnancy and childbirth, in particular gestosis, eclampsia, first pregnancy, maternal age under 20 years or over 40 years, prolonged labor. , post-term pregnancy and prematurity, low birth weight, morphofunctional immaturity, hypoxic-ischemic encephalopathy, disease of the child in the first year of life. Other risk factors include maternal use of certain medications during pregnancy, alcohol, and smoking.

Apparently, early damage to the central nervous system is associated with a slight decrease in the size of the prefrontal areas of the brain (mainly in the right hemisphere), subcortical structures, corpus callosum, and cerebellum found in children with ADHD compared with healthy peers using magnetic resonance imaging (MRI). These data support the concept that the onset of ADHD symptoms is caused by disruptions in connections between the prefrontal regions and subcortical nodes, primarily the caudate nucleus. Subsequently, additional confirmation was obtained through the use of functional neuroimaging methods. Thus, when determining cerebral blood flow using single-photon emission computed tomography in children with ADHD compared with healthy peers, a decrease in blood flow (and, consequently, metabolism) was demonstrated in the frontal lobes, subcortical nuclei and midbrain, and the changes were most pronounced at the level caudate nucleus. According to the researchers, changes in the caudate nucleus in children with ADHD were the result of its hypoxic-ischemic damage during the newborn period. Having close connections with the visual thalamus, the caudate nucleus performs an important function of modulation (mainly inhibitory in nature) of polysensory impulses, and the lack of inhibition of polysensory impulses may be one of the pathogenetic mechanisms of ADHD.

Subsequently, H. C. Lou et al. Using positron emission tomography (PET), it was established that cerebral ischemia suffered at birth entails persistent changes in dopamine receptors of the 2nd and 3rd types in the structures of the striatum. As a result, the ability of receptors to bind dopamine decreases and a functional deficiency of the dopaminergic system is formed. These data were obtained from a study of six adolescents with ADHD aged 12-14 years. Previously, these patients were part of a group of 27 children who were born prematurely at 28-34 weeks of pregnancy; within 48 hours after birth, they underwent PET scan, which confirmed hypoxic-ischemic damage to the central nervous system; When re-examined at the age of 5.5-7 years, 18 of them were diagnosed with ADHD. The results obtained show that critical changes at the level of receptors (and, possibly, other protein structures involved in the metabolism of neurotransmitters) may not only be of a hereditary nature, but also be the result of pre- and perinatal pathology.

Recently, P. Shaw et al. conducted a longitudinal comparative MRI study of children with ADHD, the purpose of which was to assess regional differences in the thickness of the cerebral cortex and compare their age-related dynamics with clinical outcomes. 163 children with ADHD (average age at inclusion in the study 8.9 years) and 166 children in the control group were examined. The follow-up period was more than 5 years. According to the data obtained, children with ADHD showed a global decrease in cortical thickness, most pronounced in the prefrontal (medial and superior) and precentral regions. Moreover, in patients with the worst clinical outcomes during the initial examination, the smallest cortical thickness was found in the left medial prefrontal region. Normalization of right parietal cortical thickness was associated with better outcomes in patients with ADHD and may reflect a compensatory mechanism associated with changes in cortical thickness.

Neuropsychological mechanisms of ADHD are considered from the standpoint of violations (immaturity) of the functions of the frontal lobes of the brain, primarily the prefrontal region. Manifestations of ADHD are analyzed from the perspective of deficits in the functions of the frontal and prefrontal parts of the brain and insufficient development of executive functions (EF). Patients with ADHD exhibit “executive dysfunction” (in English literature - executive dysfunction). The development of EF and the maturation of the prefrontal region of the brain are long-term processes that continue not only in childhood, but also in adolescence. EF is a fairly broad concept that refers to a range of abilities that serve the task of maintaining the necessary sequence of efforts to solve a problem aimed at achieving a future goal. Significant components of EF that are affected in ADHD are: impulse control, behavioral inhibition (containment); organization, planning, management of mental processes; maintaining attention, keeping away from distractions; inner speech; working (RAM) memory; foresight, forecasting, looking into the future; retrospective assessment of past events, mistakes made; change, flexibility, ability to switch and revise plans; choice of priorities, ability to manage time; separating emotions from real facts. Some EF researchers emphasize the “hot” social aspect of self-regulation and the child’s ability to control their behavior in society, while others emphasize the role of regulation of mental processes - the “cold” cognitive aspect of self-regulation.

The influence of adverse environmental factors . Anthropogenic pollution of the natural environment, largely associated with microelements from the group of heavy metals, can have negative consequences for the health of children. It is known that in the immediate vicinity of many industrial enterprises, zones with high levels of lead, arsenic, mercury, cadmium, nickel and other trace elements are formed. The most common neurotoxicant from the group of heavy metals is lead, and its sources of environmental pollution are industrial emissions and vehicle exhaust gases. Lead exposure to children can cause cognitive and behavioral disorders in children. Thus, in a survey of 277 first-graders, a direct relationship was established between increased lead levels in hair and an increase in hyperactivity, assessed using a special questionnaire for teachers. This correlation remained significant after adjusting for other factors such as age, ethnicity, gender and socioeconomic status. An even stronger relationship was observed between hair lead levels and a doctor's prior diagnosis of ADHD.

The role of nutritional factors and unbalanced nutrition. The emergence or intensification of ADHD symptoms can be facilitated by an imbalanced diet (for example, insufficient protein with an increase in the amount of easily digestible carbohydrates, especially in the morning), as well as a lack of micronutrients in food, including vitamins, folates, omega-3 polyunsaturated fatty acids (PUFAs) , macro- and microelements. Micronutrients such as magnesium, pyridoxine and some others directly affect the synthesis and degradation of monoamine neurotransmitters. Therefore, micronutrient deficiencies may affect neurotransmitter balance and therefore the manifestation of ADHD symptoms.

Of particular interest among micronutrients is magnesium, which is a natural lead antagonist and promotes the rapid elimination of this toxic element. Therefore, magnesium deficiency, among other effects, can contribute to the accumulation of lead in the body. Magnesium deficiency in ADHD has been found in several studies. According to B. Starobrat-Hermelin, when studying the mineral status in a group of 116 children with ADHD 9-12 years old, magnesium deficiency was most often detected - in 110 (95%) patients based on the results of its determination in blood plasma, red blood cells and hair. When examining 52 hyperactive children, 30 (58%) of them were found to have low levels of magnesium in red blood cells. According to Russian researchers, magnesium deficiency is detected in 70% of children with ADHD.

Magnesium is an important element involved in maintaining the balance of excitation and inhibition processes in the central nervous system. There are several molecular mechanisms through which magnesium deficiency affects neuronal activity and neurotransmitter metabolism: magnesium is required to stabilize excitatory (glutamate) receptors; magnesium is an essential cofactor of adenylate cyclases involved in signal transmission from neurotransmitter receptors to control intracellular cascades; magnesium is a cofactor for catechol-O-methyltransferase, which inactivates excess monoamine neurotransmitters. Therefore, magnesium deficiency contributes to an imbalance of “excitation-inhibition” processes in the central nervous system towards excitation and can affect the manifestation of ADHD.

Magnesium deficiency in ADHD may be associated not only with its insufficient intake from food, but also with an increased need for it during critical periods of growth and development, during severe physical and neuropsychic stress, and exposure to stress. Under conditions of environmental stress, nickel and cadmium act as magnesium-displacing metals along with lead. In addition to a lack of magnesium in the body, the manifestation of ADHD symptoms can be influenced by deficiencies of zinc, iodine, and iron.

Thus, ADHD is a neuropsychiatric disorder with a complex pathogenesis, accompanied by structural, metabolic, neurochemical, neurophysiological changes in the central nervous system, as well as neuropsychological disorders in information processing and EF.

Treatment. At the present stage, it becomes obvious that treatment of ADHD should be aimed not only at controlling and reducing the main manifestations of this disorder, but also at solving other important problems: improving the patient’s functioning in various areas and his fullest realization as a person, the appearance of his own achievements, improvement self-esteem, normalization of the situation around him, including within the family, the formation and strengthening of communication skills and contacts with people around him, recognition by others and increased satisfaction with his life. Our study confirmed the significant negative impact of the difficulties experienced by children with ADHD on their emotional state, family life, friendships, school work, and leisure activities. In this regard, the concept of an expanded therapeutic approach has been formulated, implying the expansion of the influence of treatment beyond the reduction of basic symptoms and taking into account functional outcomes and quality of life indicators. Thus, the concept of an expanded therapeutic approach involves addressing the social and emotional needs of a child with ADHD, which should be paid special attention both at the stage of diagnosis and treatment planning, and in the process of dynamic monitoring of the patient and assessing the results of the therapy.

The most effective treatment for ADHD is comprehensive care, which combines the efforts of doctors, psychologists, teachers working with the child, and his family. Treatment for ADHD must be timely and must include:

assistance to the family of a child with ADHD - family and behavioral therapy techniques that provide better interaction in families of children suffering from ADHD;
developing parents' skills in raising children with ADHD, including parent training programs;
educational work with teachers, correction of the school curriculum - through a special presentation of educational material and the creation of an atmosphere in the classroom that maximizes the opportunities for successful learning of children;
psychotherapy for children and adolescents with ADHD, overcoming difficulties, developing effective communication skills in children with ADHD during special correctional classes;
drug therapy, which should be quite long-term, since the improvement extends not only to the main symptoms of ADHD, but also to the socio-psychological side of the patients’ lives, including their self-esteem, relationships with family members and peers, usually starting from the third month of treatment. Therefore, it is advisable to plan drug therapy for several months up to the duration of the entire academic year.

An effective drug specifically developed for the treatment of ADHD is atomoxetine hydrochloride. The main mechanism of its action is associated with the blockade of norepinephrine reuptake, which is accompanied by increased synaptic transmission with the participation of norepinephrine in various brain structures. In addition, experimental studies revealed an increase under the influence of atomoxetine in the content of not only norepinephrine, but also dopamine selectively in the prefrontal cortex, since in this area dopamine binds to the same transport protein as norepinephrine. Since the prefrontal cortex plays a leading role in providing executive functions of the brain, as well as attention and memory, an increase in the concentration of norepinephrine and dopamine in this area under the influence of atomoxetine leads to a weakening of the manifestations of ADHD. Atomoxetine has a beneficial effect on the behavioral characteristics of children and adolescents with ADHD; its positive effect usually appears at the beginning of therapy, but the effect continues to increase over a month of continuous use of the drug. In most patients with ADHD, clinical effectiveness is achieved when the drug is prescribed in the dose range of 1.0-1.5 mg/kg body weight per day with a single dose in the morning. The advantage of atomoxetine is its effectiveness in cases of comorbidity of ADHD with destructive behavior, anxiety disorders, tics, and enuresis.

Domestic specialists traditionally use nootropic drugs in the treatment of ADHD. Their use in ADHD is pathogenetically justified, since nootropic drugs have a stimulating effect on insufficiently developed cognitive functions in children of this group (attention, memory, organization, programming and control of mental activity, speech, praxis). Taking into account this circumstance, the positive effect of drugs with a stimulating effect should not be perceived as paradoxical (given the hyperactivity present in children). On the contrary, the high effectiveness of nootropics seems natural, especially since hyperactivity is only one of the manifestations of ADHD and is itself caused by disturbances in higher mental functions. In addition, these drugs have a positive effect on metabolic processes in the central nervous system and promote the maturation of the inhibitory and regulatory systems of the brain.

At the same time, it should be noted that new research is needed to clarify the optimal timing of prescribing nootropic drugs in the treatment of ADHD. Thus, a recent study confirmed the good potential of the drug hopantenic acid in long-term treatment of ADHD. A positive effect on the main symptoms of ADHD was achieved after 2 months of treatment, but continued to increase after 4 and 6 months of its use. Along with this, the beneficial effect of long-term use of the drug hopantenic acid on adaptation and functioning disorders characteristic of children with ADHD in various areas, including behavioral difficulties in the family and in society, school studies, decreased self-esteem, and lack of development of basic life skills, has been confirmed. However, in contrast to the regression of the main symptoms of ADHD, longer periods of treatment were necessary to overcome adaptation disorders and socio-psychological functioning: a significant improvement in self-esteem, communication with others and social activity was observed according to the results of a parent survey after 4 months, and a significant improvement in behavioral indicators and school performance, basic life skills, along with a significant regression of risk behavior - after 6 months of use of the drug hopantenic acid.

Another direction of ADHD therapy is to control negative nutritional and environmental factors that lead to the entry of neurotoxic xenobiotics into the child’s body (lead, pesticides, polyhaloalkyls, food coloring, preservatives). This should be accompanied by the inclusion in therapy of necessary micronutrients that help reduce ADHD symptoms: vitamins and vitamin-like substances (omega-3 PUFAs, folates, carnitine) and essential macro- and microelements (magnesium, zinc, iron).

Among the micronutrients with a proven clinical effect in ADHD, magnesium preparations should be noted. In the treatment of ADHD, only organic magnesium salts (lactate, pidolate, citrate) are used, which is associated with the high bioavailability of organic salts and the absence of side effects when used in children. The use of magnesium pidolate with pyridoxine in solution (ampule form of the drug Magne B 6 (Sanofi-Aventis, France)) is permitted from the age of 1 year, lactate (Magne B 6 tablets) and magnesium citrate (Magne B 6 forte tablets) - from 6 years old. The magnesium content in one ampoule is equivalent to 100 mg of ionized magnesium (Mg 2+), in one Magne B 6 tablet - 48 mg Mg 2+, in one Magne B 6 forte tablet (618.43 mg magnesium citrate) - 100 mg Mg 2+ . The high concentration of Mg 2+ in Magne B 6 forte allows you to take 2 times fewer tablets than when taking Magne B 6. The advantage of Magne B 6 in ampoules is also the possibility of more accurate dosing. As a study by O.A. Gromova et al. showed, the use of the ampoule form of Magne B 6 provides a rapid increase in the level of magnesium in the blood plasma (within 2-3 hours), which is important for the rapid elimination of magnesium deficiency. At the same time, taking Magne B 6 tablets promotes longer (for 6-8 hours) retention of increased concentrations of magnesium in red blood cells, that is, its deposition.

The advent of combination preparations containing magnesium and vitamin B6 (pyridoxine) has significantly improved the pharmacological properties of magnesium salts. Pyridoxine is involved in the metabolism of proteins, carbohydrates, fatty acids, the synthesis of neurotransmitters and many enzymes, has neuro-, cardio-, hepatotropic, as well as hematopoietic effects, and helps replenish energy resources. The high activity of the combined drug is due to the synergistic action of the components: pyridoxine increases the concentration of magnesium in plasma and red blood cells and reduces the amount of magnesium excreted from the body, improves the absorption of magnesium in the gastrointestinal tract, its penetration into cells, and fixation. Magnesium, in turn, activates the process of transformation of pyridoxine into its active metabolite pyridoxal-5-phosphate in the liver. Thus, magnesium and pyridoxine potentiate each other’s action, which makes it possible to successfully use their combination to normalize magnesium balance and prevent magnesium deficiency.

Data on the positive clinical effect of the drug Magne B 6 in the treatment of children with ADHD with a confirmed lack of magnesium in the body are presented in several foreign studies. Combined intake of magnesium and pyridoxine for 1-6 months reduced ADHD symptoms and restored normal values of magnesium in red blood cells.

O.R. Nogovitsina and E.V. Levitina compared the results of treatment of 31 children with ADHD aged 6-12 years with Magne B 6 and 20 patients in the control group who received a multivitamin preparation. The observation period lasted one month. According to a parent survey, by the 30th day of treatment in the main group, scores on the “anxiety”, “attention disturbance and hyperactivity” scales significantly decreased. The decrease in anxiety levels was also confirmed by the results of the Luscher test. During psychological testing, the patients of the main group significantly improved their concentration, accuracy and speed of completing tasks, and the number of errors decreased. Neurological examination revealed an improvement in gross and fine motor skills, positive dynamics of EEG characteristics in the form of disappearance of signs of paroxysmal activity against the background of hyperventilation, as well as bilateral synchronous and focal pathological activity in the majority of patients. At the same time, taking the drug Magne B 6 was accompanied by normalization of the concentration of magnesium in the erythrocytes and blood plasma of patients. Thus, the proportion of cases of severe magnesium deficiency in blood plasma decreased by 13% (from 23 to 10%), moderate deficiency by 4% (from 37 to 33%), and the number of patients with normal values increased from 40 to 57%.

Replenishment of magnesium deficiency should last at least two months. Considering that nutritional magnesium deficiency is the most common, when drawing up nutritional recommendations, one should take into account not only the quantitative content of magnesium in foods, but also its bioavailability. Thus, fresh vegetables, fruits, herbs (parsley, dill, green onions) and nuts have the maximum concentration and activity of magnesium. When preparing products for storage (drying, canning), the concentration of magnesium decreases slightly, but its bioavailability drops sharply. This is important for children with ADHD who have a worsening magnesium deficiency coinciding with the school period from September to May. Therefore, the use of combination drugs containing magnesium and pyridoxine is advisable during the school year.

Thus, the efforts of specialists should be aimed at early detection of ADHD in children. The development and application of complex correction must be carried out in a timely manner and be individual in nature. Treatment for ADHD, including medication, must be long-term.

List of used literature

References

Attention deficit disorder is the most common neurological and behavioral disorder. This deviation is diagnosed in 5% of children. Most often found in boys. The disease is considered incurable; in most cases, the child simply outgrows it. But pathology does not disappear without a trace. It manifests itself in depression, bipolar and other disorders. To avoid this, it is important to promptly diagnose attention deficit in children, the signs of which appear in preschool age.

It is very difficult to distinguish between ordinary self-indulgence or bad manners from truly serious disorders in mental development. The problem is that many parents do not want to admit that their child is sick. They believe that unwanted behavior will go away with age. But such a trip can lead to serious consequences for the health and psyche of the child.

Characteristics of attention deficit disorder

This neurological developmental disorder began to be studied 150 years ago. Educators and psychologists have noticed common symptoms in children with behavioral problems and learning delays. This is especially noticeable in a team, where it is simply impossible for a child with such a pathology to avoid trouble, because he is emotionally unstable and cannot control himself.

Scientists have identified such problems as a separate group. The pathology was given the name “attention deficit in children.” Signs, treatment, causes and consequences are still being studied. Doctors, teachers and psychologists are trying to help such children. But so far the disease is considered incurable. Does attention deficit manifest itself in the same way in children? Its signs allow us to distinguish three types of pathology:

Just a lack of attention. slow, unable to concentrate on anything.
Hyperactivity. It is manifested by short temper, impulsiveness and increased physical activity.
Mixed look. It is the most common disorder, which is why the disorder is often called attention deficit hyperactivity disorder (ADHD).

Why does such a pathology appear?

Scientists still cannot accurately determine the causes of the development of this disease. Based on long-term observations, it has been established that the appearance of ADHD is provoked by the following factors:

Genetic predisposition.
Individual characteristics of the nervous system.
Bad ecology: polluted air, water, household items. Lead is especially harmful.
The impact of toxic substances on the body of a pregnant woman: alcohol, medicines, products contaminated with pesticides.
Complications and pathologies during gestation and labor.
Trauma or infectious lesions of the brain in early childhood.

By the way, sometimes pathology can be caused by an unfavorable psychological situation in the family or an incorrect approach to education.

How to diagnose ADHD?

It is very difficult to make a timely diagnosis of attention deficit in children. Signs and symptoms of pathology are clearly noticeable when problems in the child’s learning or behavior already appear. Most often, teachers or psychologists begin to suspect the presence of a disorder. Many parents attribute such deviations in behavior to adolescence. But after examination by a psychologist, attention deficit in children can be diagnosed. It is better for parents to study the signs, treatment methods and behavioral characteristics with such a child in detail. This is the only way to correct behavior and prevent more serious consequences of pathology in adulthood.

But to confirm the diagnosis, a full examination is necessary. In addition, the child should be monitored for at least six months. After all, the symptoms may coincide in various pathologies. First of all, it is worth excluding visual and hearing disorders, the presence of brain damage, seizures, developmental delays, exposure to hormonal drugs or poisoning with toxic substances. To do this, psychologists, pediatricians, neurologists, gastroenterologists, therapists, and speech therapists must participate. In addition, behavioral disorders can be situational. Therefore, the diagnosis is made only for persistent and regular disorders that manifest themselves over a long period of time.

Attention deficit in children: signs

Scientists have not yet fully figured out how to treat it. The difficulty is that the pathology is difficult to diagnose. After all, its symptoms often coincide with ordinary developmental delays and improper upbringing, possibly spoiling the child. But there are certain criteria by which pathology can be identified. There are the following signs of attention deficit disorder in children:

Constant forgetfulness, failure to keep promises and unfinished business.
Inability to concentrate.
Emotional instability.
An absent look, self-absorption.
Absent-mindedness, which manifests itself in the fact that the child loses something all the time.
Such children are unable to concentrate on any one activity. They cannot cope with tasks that require mental effort.
The child is often distracted.
He exhibits memory impairment and mental retardation.

Hyperactivity in children

Attention deficit disorder is often accompanied by increased motor activity and impulsivity. In this case, it is even more difficult to make a diagnosis, since such children usually do not lag behind in development, and their behavior is mistaken for bad manners. How does attention deficit manifest itself in children in this case? Signs of hyperactivity are:

Excessive talkativeness, inability to listen to the interlocutor.
Constant restless movements of the feet and hands.
The child cannot sit quietly and often jumps up.
Aimless movements in situations where they are inappropriate. We are talking about running and jumping.
Unceremonious interference in other people's games, conversations, activities.
continues even during sleep.

Such children are impulsive, stubborn, capricious and unbalanced. They lack self-discipline. They can't control themselves.

Health problems

Attention deficit in children is not only manifested in behavior. Its signs are noticeable in various mental and physical health disorders. Most often this is noticeable by the appearance of depression, fear, manic behavior or nervous tics. The consequences of this disorder are stuttering or enuresis. Children with attention deficit disorder will have decreased appetite or sleep disturbances. They complain of frequent headaches and fatigue.

Consequences of pathology

Children with this diagnosis inevitably have problems in communication, learning, and often in health. People around him condemn such a child, considering his deviations in behavior to be whims and bad manners. This often leads to low self-esteem and bitterness. Such children begin to drink alcohol, drugs, and smoke early. During adolescence, they exhibit antisocial behavior. They often get injured and get into fights. Such teenagers can be cruel to animals and even people. Sometimes they are even ready to kill. In addition, they often exhibit mental disorders.

How does the syndrome manifest in adults?

With age, the symptoms of the pathology subside a little. Many people manage to adapt to normal life. But most often, signs of pathology persist. What remains is fussiness, constant anxiety and restlessness, irritability and low self-esteem. Relationships with people deteriorate, and patients are often in constant depression. Sometimes they are observed which can develop into schizophrenia. Many patients find comfort in alcohol or drugs. Therefore, the disease often leads to complete degradation of a person.

How to treat attention deficit in children?

Signs of pathology can be expressed in different ways. Sometimes the child adjusts and the disorder becomes less noticeable. But in most cases, it is recommended to treat the disease in order to improve the life of not only the patient, but also those around him. Although the pathology is considered incurable, certain measures are still taken. They are selected individually for each child. Most often these are the following methods:

Drug treatment.
Behavior correction.
Psychotherapy.
A special diet that excludes artificial additives, dyes, allergens and caffeine.
Physiotherapeutic procedures - magnetic therapy or transcranial microcurrent stimulation.
Alternative methods of treatment - yoga, meditation.

Behavior correction

Nowadays, attention deficit in children is becoming more and more common. The signs and correction of this pathology should be known to all adults who communicate with a sick child. It is believed that it is impossible to completely cure the disease, but it is possible to correct the behavior of children and make it easier for them to adapt to society. This requires the participation of all people around the child, especially parents and teachers.

Regular sessions with a psychologist are effective. They will help the child overcome the desire to act impulsively, control himself and react correctly to offense. For this, various exercises are used and communicative situations are modeled. A relaxation technique that helps relieve tension is very useful. Parents and teachers need to constantly encourage the correct behavior of such children. Only a positive reaction will help them remember for a long time how to act.

Drug treatment

Most medications that can help a child with attention deficit disorder have many side effects. Therefore, such treatment is used infrequently, mainly in advanced cases, with severe neurological and behavioral abnormalities. Most often, psychostimulants and nootropics are prescribed, which affect the brain, help normalize attention and improve blood circulation. Antidepressants and anti-anxiety medications are also used to reduce hyperactivity. The most common medications for the treatment of ADHD are the following drugs: Methylphenidate, Imipramine, Nootropin, Focalin, Cerebrolysin, Dexedrine, Strattera.

Through the joint efforts of teachers, psychologists and other specialists, we can help the child. But the main work falls on the shoulders of the child’s parents. This is the only way to overcome attention deficit in children. The signs and treatment of pathology for adults must be studied. And when communicating with your child, follow certain rules:

Spend more time with your baby, play and study with him.
Show him how much he is loved.
Do not give your child difficult and overwhelming tasks. Explanations must be clear and understandable, and tasks must be quickly achievable.
Constantly increase the child's self-esteem.
Children with hyperactivity need to play sports.
You need to follow a strict daily routine.
Undesirable behavior of a child should be gently suppressed, and correct actions should be encouraged.
Overwork should not be allowed. Children should definitely get enough rest.
Parents need to remain calm in all situations in order to be an example for their child.
For training, it is better to find a school where an individual approach is possible. In some cases, home schooling is possible.

Only an integrated approach to education will help a child adapt to adult life and overcome the consequences of pathology.