Beyond Attention Deficit Disorder
 

Attention Deficit Disorder                                  Home Page

General definition:
Excessive tendency to distraction, which appears in an insidious, often diverting, or selective and occasional way. It shows more with the constraints of teaching and education, as the child grows and gets older. Its seems to be something of a bad will, some unwillingness, lack of interest or motivation, intellectual idleness, and even false depressive or worse psychotic state.

This problem seriously handicaps academic successes, as the individual potential, and often leads to failures, even to school desertion. Its gives a peripheral attention, as the secondary stimuli will have as much importance than the primarty stimulus, if not more, involving splitting interests. Sometimes, it succeeds in decreasing the capacity of judgement of reality and supports fabulation, daydreaming or fantastic thoughts. Other times, it merges completely with the difficulties of the general behavior like opposition and conduct disorder.

It remains useful to consider the attention deficit to the image of the allergy, for example. Initially a sensitivity which can become an occasional handicap and then a disease, if nobody knows the mechanism of it and is not concerned with prevention, and treatment, if necessary. The concept even of temperament can be fundamental and make it possible to better define what belongs to the initial nature of the individual. So that the attention deficit remains a clinical entity, one needs to connect it closely to the real or eminently apprehended failure. The notion of running time could be seriously diminished, making any planning impossible. The overactivity may happened once in a while, but be of less importance than in full ADHD.

Particular features:
1. Tendency of daydreaming in the rather monotonous and tiresome tasks,
• of more auditive than visual, or more abstract than concrete nature, like the school matters, the duties and lessons;
• but better concentration in the physical, manual, mechanical activities like data-processing, audiovisual field: TV, video games, etc.
2. Inattentive mind toward the constraints, instructions, and frequent lapses of memory in the daily businesses.
3. Rather attentive vigilance in the activities under pressure and high speed: competition, race etc.
4. Tendency to lose its personal and familiar belongings: keys, pencils, books, etc.
 5. Variable maturity of character in regard to the limits, the frustration tolerance, the impulses control, the self-esteem stability, the capacity of living and sharing the attention, as well as the sense of organization in time (punctuality, schedules) and space it (the territory).
6. Greater excitability in groups, and need to make fun, jokes, and distract others.
7. School danger of failure, as approach the more abstract matters of high school or university studies, generally the study of languages (grammar, orthography) and of complex mathematics.

Prevalence:
There is always a ratio of 4-5 boys for 1 girl, making it believe that there are immunogenetic and biological components as much as maturationnal and evolutionary features. Often a close family person suffers from the problem. Approximately 3-5 % of children and adolescents of school age would have this problem and half of them will also suffer of learning difficulties. In girls, one finds more often the pure form of ADD without behavioral dimension like the disorder of opposition, making the diagnosis more difficult.

Etiology:
It does not seem to exist particular links with the only perinatal or antenatal factors, separately taken. Apart from the toxic factors (alcoholism, drug, nicotine, malnutrition), metabolic diseases of pregnancy, let us not forget that the life starts at the time of its origin, where are played the great laws of the universal genetics: the farther ‘s part of the embryo constitutes a half-transplant for the mother who develops antibodies of rejection. The conditions of fœtal development would depend mainly on this primitive and fondamental incompatibility, always relative, but able to really complexify the embryogenesis of the brain, in particular. The presence of the chromosome " Y " of the boy adds a considerable characteristic. All things considered, if the laws of the genetics apply, it is well far from the only and direct transmission of a closed relative to the child.

Comments:
It is often difficult to know, at the children, if it is about a problem of neurobiologic, maturation, anxiety or of depression. There is often mixture of the three or four elements, with the deficit attention, playing the discrete role of cornerstone of the others conditions. A differential diagnosis is essential with the professionnal who is interested as much at the biological origin as psychic symptoms and can distinguish between situational, neurodeveloppemental, nevrotic or well seldom occurring psychotic state. The deficit attention will usually not appear in an intimate relationship at two people. Its mostly disappears in a peaceful or structured, stimulative activity. Nothing better than a task of routine, as often happens in some schoolworks.

Treatment:
1. Initially, never to be alarmed too much in front of an infantile delay of maturation, in spite of the sum of the negative symptoms, especially in view of all the potential that so largely exceeds any small handicaps.
2. Then, take time to give a good understanding of the neurobiologic, cognitive, psychological and emotional development.
3. Consider those different approches:
a- Parental guidance, directed towards the explanations and the comprehension of general and specific psychology,
b- Cognitive therapies (attitudes and behaviors), psychoaffective (self-esteem and feelings).
c- Specific teaching, according to children needs, especially in the learning difficulties.
d. The medication: drugs, like methyphenidate, which will be the same ones as in the hyperactivity, because there is mainly an over brain activism instead of a purely motor agitation. Indicated when there is danger of school failure, social isolation, and family disruption.

 

Dr Claude Jolicoeur, Child Psychiatrist 
Montreal, february 2000. ®

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