Its important for children development to participate in all activities of their age. Being rejected by peers is a painful experience, unfortunately, often experienced by children with ADHD. Its difficult to make friends and  maintain their friendships for these children. It is important to consider the wellbeing of these children , and everyone in their inner circle to be able to help them. This guide is for parents and children affected by the disorder. This article will give some answers to the questions that you are interested in the treatment of ADHD. The article contains an overview of ADHD, its diagnosis and treatment, could be used as a guide by children, parents and teachers. There is a list of organizations where you can find support as well.

ADHD: What is it?

Hyperactivity attention deficit Disorder (ADHD), which is characterized by difficulties in concentrating and maintaining sustained attention, accompanied by impulsivity which often leads to restlessness, constant fidgeting or overactivity.

ADHD is a most common in children and adolescents. It affects 3-5 percent of school-age children. In statistical terms, this represents at least one student  in every  class. Boys are more affected by ADHD, than girls. Among them, the disease is more easily noticed , because the two components hyperactivity and impulsiveness are often more prevalent, unlike the girls in which distraction is less visible. Their presentation is often unjustly considered as timidity.

In most cases, the characteristic behaviors and poor school performance are observed in primary schools, but sometimes they are seen in high school and college. It is not unusual that some family members are affected given the genetic predisposition to ADHD. Several genes that are responsible for attention, planning and organization of action, recording and sorting of important information such as the removal of secondary information from the environment seems to be involved in the patophysiology of the disorder.

Children with ADHD are inattentive and easily distracted. They have problems with reading instructions to the end. Similarly, they fail to sit still. These children have difficulties to wait their turn and focus long enough on a task, especially if they found it monotonous.

Children with ADHD are often punished by teachers and parents, they suffer from taunts and provocations from their comrades. They are rarely invited to outside school events (, for example, birthdays), which can affect their self-esteem and emotional well-being.

The main signs of each behavioural problem are detailed below.

Inattentiveness

The main signs of inattentiveness are:

• having a short attention span and being easily distracted
• making careless mistakes – for example, in schoolwork
• appearing forgetful or losing things
• being unable to stick at tasks that are tedious or time-consuming
• appearing to be unable to listen to or carry out instructions
• constantly changing activity or task
• having difficulty organising tasks

Hyperactivity and impulsiveness

The main signs of hyperactivity and impulsiveness are:

• being unable to sit still, especially in calm or quiet surroundings
• constantly fidgeting
• being unable to concentrate on tasks
• excessive physical movement
• excessive talking
• being unable to wait their turn
• acting without thinking
• interrupting conversations
• little or no sense of danger Disorders often associated with ADHD

Many children with ADHD also have other comorbidities

• anxiety disorder
• oppositional defiant disorder (ODD)
• conduct disorder
• depression
• sleep problems
• autistic spectrum disorder (ASD)
• epilepsy
• Tourette’s syndrome
• learning difficulties – such as dyslexia

ADHD’s impact on daily life

ADHD causes visible violations throughout the day for most children. If school life is their most difficult test, it does not change the fact that the symptoms of ADHD for many people can occur immediately after waking up and continue until going to sleep, which changes the lives of the whole family.

Therefore, we understand why many children are not out of danger, although the determined school issues. These children also need help outside school hours - at home, sports and other activities.

ADHD: Consequences for family and environment
Morning / family

• Difficulty getting up
• Sustainable during bathing and toileting
• Agitation during breakfast
• Difficulties in the preparation of school

Conflicts, loss of time
Morning / school

• During classes
• Reprimands and punishments
• Lack of attention
• learning difficulties
• Variable results

Failure at school
In the afternoon at school, with friends and family

• Agitation and tension in the preparation at home
• Passing through games and sports activities

The participation in the regular activities is difficult.
Night / family

• Disputes with brothers and sisters
• Agitation and tension during diner

Emotional burden and a waste of time for the family

Difficulties - caution
hyperactivity
impulsiveness
Conflicts in relationships
low self-esteem
emotional lability
exclusion
Deterioration of relations with people of the same age

ADHD also leads to social and emotional problems

Admonitions and punishments, accidents and bad ratings (although the important work and monitoring by the parents), provocations and taunts of classmates, the lack of friends ... Facing these pitfalls the child is disappointed, discouraged; he loses confidence in himself and suffers from depressive disorders. The parents are exhausted and the siblings are isolated in their room, teachers speak of a special school and the child is tormented by guilt and dreams of escape.

ADHD & Adolescence: a particular challenge

In case of incomplete therapeutic strategy, regression of the symptoms of ADHD is inadequate, and the emotional and social problems worsen, particularly during puberty, and at the end of puberty. Irritation, internal and external excitement, anger and brutal burden lie on friendly relations. Despite the ability of the child and efforts, school results often remain below the requirements. Stage fright during exams also contributes to the low success rate. This kind of disappointments can contribute to risky behaviors such as extreme sports, unprotected sex, drug use. However, it is possible to limit these negative effects by providing pharmacological treatment and developing the creativity of the patient (music, art or theater).

ADHD: How to diagnose?

The diagnosis of ADHD is not easy and often requires multiple tests. In most cases, the doubt comes from parents, teachers, related people or friends. The description of the problems of parents and teachers, monitoring and medical history of the child and family play an important role in determining the diagnosis. 

Questionnaires for school and family environment, developed on the basis of the criteria described by the classification of the World Health Organization (ICD- 10) and the American Psychiatric Association (DSM -V) are proven to describe the behavior of the child. Neurologic tests help identify normal intelligence, attention and hyperactivity. More trials are needed of suspected comorbidities.

ADHD: How to treat?

Children with ADHD and their families need information and support! Many scientific studies have shown that long multimodal therapy offers better chances of success. It consists of three elements:

• Information and recommendations to the attention of the children, their parents and teachers;
• Treatment of accompanying symptoms and emotional impact;
• Pharmacological treatment.

1. Information and recommendations to the attention of the children, their parents and teachers

Recommendations to the attention of the child

• Describe as accurately as possible the problems you encounter in school, at home and with your classmates!
• Select the issues that you want to overcome. The first problem!
• Think about how you can achieve these goals and make a plan!
• Write down and note the time when you have noticed them!
• Do not be discouraged and do not give up if you do not reach an interim goal!
• Be proud of yourself when you have achieved a certain goal and be happy to be rewarded by your parents!

Recommendations for parents

• Do not limit yourself to make homework with your child and teach him. Also do not forget to play with him, to share sports activities, to travel with him or visiting monuments!
• Do not neglect your own needs or those of your other children!
• Accept difficulties meeting your child. He is not lazy and he does not make mistakes intentionally.
• Do not waste your energy doing homework with your child! Several hours of support provided to several times a week with the help of an outsider will relieve you and your child.
• Clean desk of your child from everything that is not necessary, such as toys or food!! His brothers and sisters should be able to withdraw quietly in his room.
• Close your eyes, when possible, avoid criticism, praise your child at every success!
• Make a list of clear rules (some) applicable to all children! This applies to the behavior and promotes the security and order.
• Try to remain calm, to stay in control, even in stressful situations!
• Create a schedule with your child, which allows sufficient time for activities and everyday tasks: school preparing, clothes choosing, turndown, relaxation, sports training and games.

Recommendations for teachers

• Make sure that this child is sitting as close as possible to your desk to be able to help him and encourage discreetly. The place should be possible peaceful, away from doors, windows and rebellious classmates.
• Tell your instructions short, clearly and positively, if possible orally and in writing!
• Make sure the child has understood your instructions!
• When the child does not stay at place, trust him some work tasks, like throw the trash, to seek materials or wipe board!
• Emphasize the success and good child results and avoid talking about his failures in front of the whole class!

2. Treatment of comorbidities and emotional consequences

Simultaneous disorders require specific treatment, such as therapy with a speech therapist or psychomotor therapy. To treat the emotional impact of ADHD, behavioral therapy or psychotherapy can be helpful for this child and sometimes even for his parent

Medication Indicated for the treatment of ADHD

For many children with ADHD (not all), drug treatment is necessary. This reduces many of the symptoms and is part of the overall therapeutic measures.
Two groups of drugs have proven to be useful for the treatment of ADHD:

• Stimulant medications such as methylphenidate (Ritalin®, Concerta, Medikinet®, Focalin®)
• Non-stimulant medications such as atomoxetine (Strattera®)

These two groups have advantages and disadvantages. One major difference is the duration of action. While methylphenidate is effective to 4, 8 or 12 hours after the use (depending on the formulation used), atomoxetine   showed a consistent effect throughout the day. Atomoxetine reduces ADHD symptoms and can improve performance in school, encourage the child's relationship with his family and friends (fewer difficulties encountered throughout the day, improves emotional well-being), a beneficial effect on confidence.

Is it enough drug treatment for ADHD?

Medication is not sufficient on its own. Medical treatment complements other multimodal approaches and increases their efficiency.