Disruption of activity and attention in children

Disruption of activity and attention is a group of disorders, combined according to the phenomenological principle on the basis of weakly modulated behavior with age-inappropriate hyperactivity, attention deficit, impulsivity and lack of sustained motivation for activities requiring willpower.

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

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Epidemiological studies performed in different countries demonstrate a wide variation in indicators (from 1-3 to 24-28%) in the population. This may indicate actual local causes that lead to the growth of this mental pathology in specific regions. Much of the research is not very comparable due to differences in methodology and technical methods, criteria for diagnosis, heterogeneity of the studied groups of children. Most psychoneurologists point to 3-7% of children of school age. In boys, hyperkinetic disorders are 4–9 times more common than in girls.

[8], [9], [10], [11], [12], [13], [14],

Causes of the disorders of activity and attention in children

Etiology is not fully established. There are three groups of factors that can serve as causes of the development of the syndrome - biomedical or cerebral-organic factors, genetic and psychosocial. The independent significance of psychosocial factors is doubtful, most often they reinforce manifestations of the syndrome of genetic, cerebral-organic or mixed genesis.

[15], [16], [17], [18], [19]

Pathogenesis

The results of biochemical studies have shown that the major neurotransmitter systems of the brain (dopaminergic, serotonergic, and noradreninergic) play an important role in the pathogenesis. It was established that there are fundamental differences in the exchange of monoamines in this pathology. The ambiguity of biochemical parameters is explained by the pathogenetic heterogeneity of the syndrome.

Pathological changes are recorded in different parts of the brain - the prefrontal areas of the cerebral cortex, the posterior associative center, the thalamic region, the pathways.

[20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30]

Symptoms of the disorders of activity and attention in children

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

Preschool children are distinguished from peers by high motor activity already in the first years of life. They are in constant motion, run, jump, try to climb, where they can, grab everything that is in front of their eyes, without thinking, break and throw objects. They are guided by tireless curiosity and “fearlessness”, which is why they often find themselves in traumatic situations - they can fall into the pits, undergo a shock, break down from a tree, get burned, etc. They can't wait. The desire must be fulfilled here and now. When holding, refusing, noticing, children arrange hysterics or experience anger, often accompanied by verbal and physical aggression.

Symptoms of disturbed activity and attention

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Forms

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

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

The diagnosis of "hyperkinetic behavior disorder" is made when there are complete criteria for both hyperkinetic and behavioral disorders (F90.1).

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

• with a predominance of hyperactivity / impulsivity;
• with a predominance of attention disorders;
• mixed, in which hyperactivity is combined with a violation of attention.

A number of domestic researchers carry out differentiation according to the clinical-pathogenetic principle. Encephalopathic forms are distinguished, in the genesis of which early organic lesions of the central nervous system, dystontogenetic forms with asynchronous development (as the age equivalent of emerging psychopathies and character accentuations) and mixed variants play a significant role.

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Diagnostics of the disorders of activity and attention in children

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

• Behavioral problems should have an early onset (at the age of 6 years) and a long duration.
• Disorders require abnormal levels of inattention, hyperactivity, impulsivity.
• Symptoms should be noted in more than one situation (at home, at school, clinic).
• Symptoms are detected by direct observation and are not caused by other disorders, such as autism, affective disorder, etc.

Diagnosis of impaired activity and attention

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Prevention

The earliest possible conduct of pathogenetically substantiated therapy that minimizes the influence of psychosocial factors that determine the further development of the psychopathological state. The pediatrician’s task is to recommend parents consulting a child with a psychiatrist or neurologist if the patient has signs of hyperactivity.

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