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Attention deficit hyperactivity disorder (ADHD) is one of the most common mental health disorders of childhood. The symptoms of ADHD (inattention, impulsive behavior, and hyperactivity) begin in childhood and often persist into adulthood. These symptoms frequently lead to functional impairment in academic, family and social settings. The percentage of children ever diagnosed with attention deficit hyperactivity disorder (ADHD) increased from 7% to 9% from 1998–2000 through 2007–2009.
In Egypt prevalence rate of ADHD among the studied sample was 6%, and the prevalence rate of different subtypes in order of frequency was as follows; hyperactive-impulsive. Male to female ratio was 1.5:1. The prevalence of males were common than females in the hyperactive-impulsive and combined types, while the reverse in the inattentive type.
ADHD has significant impact on the child’s social, psychological and scholastic functioning. Social skills in children with ADHD often are significantly impaired. Problems with inattention may limit opportunities to acquire social skills or to attend to social cues necessary for effective social interaction, making it difficult to form friendships. Hyperactive and impulsive behaviors may result in peer rejection. The negative consequences of impaired social function (e.g., poor self-esteem, increased risk for depression and anxiety) may be long-standing
The most commonly used criteria for the diagnosis of both children and adults are those provided in DSM-IV and in ICD-10. The DSM criteria break down symptoms into two groups: inattentive and hyperactive-impulsive. Six of the nine symptoms in each section must be present for a ‘combined type’ diagnosis of ADHD. Additionally, symptoms must be: chronic (present for 6 months), maladaptive, functionally impairing across two or more contexts, inconsistent with developmental level and differentiated from other mental disorders.
The school environment, program, or placement is an important part of the treatment which includes Psychological therapies include psycho educational input, behavioral therapy, cognitive behavioral therapy in individual and group formats, interpersonal psychotherapy, family therapy, school-based interventions, social skills training and parent management training to encourage the development of coping strategies for managing the behavioral disturbance of ADHD. For elementary school–aged children (6–12 years of age), the primary care clinician should prescribe drug administration–approved medications for ADHD evidence. The evidence is particularly strong for stimulant medications and sufficient but less strong for atomoxetine.
Compared with the normative population sample, parents reported that ADHD children consistently displayed more demanding, noisy, disruptive, disorganized and impulsive behavior. Significantly more parents reported that ADHD children experienced challenges throughout the day, from morning until bed time, compared with the normative population sample. ADHD was reported to impact most significantly on activities such as homework, family routines and playing with other children. Observational studies have found differences between parents of ADHD and non-ADHD children and weaker parenting behavior is most pronounced among parents of ADHD children
Empirical evidence indicates that parental training programs can improve parenting skills, reduce parental stress, and reduce the child’s aggressive behavior in families with ADHD children. Several parent training programmes built on learning theory have been developed for problem prevention and treatment of ADHD during the last few decades. Some programmes have been in the format of individual contacts with families, but often a group format has been used. Programmes share features such as training in reinforcement and problem-solving strategies, promotion of positive parent – child interactions and of emotional communication. The positive effects of psycho-stimulant treatment for ADHD children is well documented, but a combination of pharmacological therapy and psychosocial or behavioral modification treatment seems most effective.
Not every person with ADHD will have all of the symptoms, and the severity of the symptoms of ADHD and level of impairment will vary between individuals. In addition, ADHD symptoms and severity can change with age. Some symptoms, such as hyperactivity-impulsivity, diminish abruptly or present differently with age; other symptoms, such as inattention, are more likely to persist into adulthood. Many people with ADHD have one or more associated problems, such as learning difficulties or anxiety
For school-aged children with ADHD, psycho-stimulant medication is the treatment of choice. Methylphenidate is recommended for use as part of a comprehensive treatment program for children with a diagnosis of severe Attention Deficit/ Hyperactivity Disorder All forms of MPH are not recommended to exceed 60 mg per day. The dosage prescribed to a patient is determined by their severity of symptoms, body weight, and rate of metabolism.
Atomoxetine is the first non-stimulant to be approved for the treatment of ADHD and the first drug to be licensed for the treatment of ADHD in adults. Atomoxetine is a suitable first-line alternative as It may be particularly useful for children who do not respond to stimulants, emerging side effects or whose medication cannot be administered during the day.
A child with ADHD may be more challenging because ADHD symptomology is related to various behavioral problems. A child’s ADHD symptoms can put a strain on the parent-child relationship and elicit negative parenting strategies such as coercion and rejection.
Empirical evidence indicates that parental training programs can improve parenting skills, reduce parental stress, and reduce the child’s aggressive behavior in families with ADHD children. Several parent training program built on learning theory have been developed for problem prevention and treatment of ADHD and/or ODD during the last few decades. Some program have been in the format of individual contacts with families, but often a group format has been used. Program share features such as training in reinforcement and problem-solving strategies, promotion of positive parent – child interactions and of emotional communication. The positive effects of psycho-stimulant treatment for ADHD children is well documented, but a combination of pharmacological therapy and psychosocial or behavioral modification treatment seems most effective
The study hypothesizes that combined parental training with stimulant medications will have better outcomes than medications alone for children affected with ADHD.
This a follow-up prospective case control study. This study was conducted in child Psychiatry unit at El Abbassia Mental Health Hospital where 30 patients with ADHD and their parents were been recruited to participate in the study. The children undergo first through a diagnostic interview through the ICD10 check list, they has been divided into 2 equal groups. The first group, which is the study group, children with ADHD will received stimulant medications (with dose of 0.5-1 mg/kg) and the parents received the parental training. The second group, which is the control group, received stimulant medication (with the same dose) only.
Parental training program based on social learning theory proposed by Stephen scott and incredible year The Arabic version “Parenting program for behavior management” used in this study has been adapted for the use with the Egyptian parents by the “Administration for Children and Adolescents, General Secretariat for Mental Health” and performed by the principal researcher of the study aided by one of the psychologists this was given as a session per week for 8 consecutive weeks where the impact of parental training where assessed by pre and post Conners’ test also the control group who took pharmacological treatment only where assessed pre and post the 8 weeks.
In summary the parental training group showed statically significant results in oppositional, cognitive / inattention problem, ADHD index, CGI- emotional labiality, CGI-total, DSM-4 Hyperactive-Impulsive symptom and DSM4-total symptoms components. While the medication only group showed improvement in cognitive / inattention problem and social components of the Conner’s test.
The changes stated in the Conners’ ”Parenting program for behavior management” create a structured, predictable environment in which they reward positive behaviors and apply negative contingencies in response to problem behaviors. Reinforcements can include praise,positive attention, or tangible rewards; and depending on the severity of the child’s inappropriate behavior, punishments can take the form of loss of previously earned rewards, time-out, or other contingencies such as ignoring which is been recommended to be a part of the ADHD management plan.