Introduction
ADHD is severe neuropsychiatric disorder. According to the guidelines set by the American Academy of Pediatrics, children aged between six and twelve are vulnerable to this disease if they show diagnostic symptoms like inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems.1.
However, there are some concerns in identifying the children with ADHD. (Sayal et al. 2006) described in a report that support should be initiated from the parents in, recognizing the problem and seeking the help of the educational professionals.2.
From the data obtained in an earlier study, it was observed that the prevalence of ADHD in U.S children almost correlates with that in non-US children and it was also revealed that ADHD is not purely American disorder (Faraone et al., 2003). This report may be further strengthened if associated with a study conducted in Argentina that revealed similarity in ADHD prevalence rates with other countries. (Michanie et al., 2007).
Description of symptoms in children
Children with ADHD have poor academic and educational performance as reported in a study (Loe and Feldman, 2007). Hence, school studies are very crucial in predicting the vulnerability to ADHD.Some diseases often present other symptoms that might help in easy diagnosis. Holmberg and Hjern (2006) reported that ADHD is better associated with recurrent abdominal pain (RAP), sleeping problems and tiredness and emphasized on assessing their role to evaluate ADHD.
The habits or behavior pattern of ADHD subjects may also guide to a great extent in detecting the disaese. (Wilens 2007) described that ADHD might predispose the individuals to substance use disorders (SUD) like cigarette smoking at a latter stage.
Further, suicidal behavior is another complaint in ADHD patients and aggression is found to play vital role in connecting suicide with ADHD, as reported in a study (Goodman et al., 2008).
Hence, ADHD seems to have a plethora of complications.
Previously, to better understand the problem of ADHD two psychological treatments like parent training and social skills training were suggested (Cousins and Weiss, 1993).Thus, it can be inferred that the problem of ADHD could be easily overcome if intervention programs in the society are better implemented provided there is continuous cooperation from parents.
Further, it is essential that some remedies are worked out to counteract the incidence of ADHD.
As therapy is always associated with possible side effects, there is a need to look for a safer approach.
Nutrition has better implications for controlling ADHD in children. Dykman and Dykman (1998) previously reported about a nutritional supplement consisting of sacchaarides, and flash dried fruits and vegetables having the potential to reduce the severity of ADHD. To consider other, dietary problems in ADHD children are characterized by high intake of iron and vitamin C along with a difference in fatty acid composition (Chen et al., 2004).Therefore a balnced diet may be the better choice for children with ADHD.
Further,the requirement of essential nutrients is considered vital during the etiopathogenesis of many health problems. Arnold and Desilvestro (2005) reported that ADHD children have low levels of zinc in serum, red cells, hair, urine and nails. Hence zinc supplementation may be beneficial to ADHD children.
Secondly, maternal nutrient factors are also crucial for ADHD children. It was shown that the short duration of breast feeding was considered as a risk factor for ADHD (Kadziela-Olech H and Piotrowska-Jastrzebska (2005).Therefore child nourishing factors have to be thoroughly evaluated.
Cormier and Elder (2007) provided histrotical background information about diet supplementation for children with ADHD and other behavior disorders. Curtis and Patel (2008) in a review have highlighted the beneficial role of nutrients such as omega-3 fatty acids, vitamins, zinc, magnesium, and phytochemicals for ADHD patients. McNamara and Carlson (2006) highlighted the potential role of omega3 fatty acid docosahexaenoic acid (DHA), another nutrient candidate reported to play key role in the psychopathology of ADHD.It can be inferred that nutrition has broad spectrum health benefits for ADHD children.
Previously, treating ADHD children was considered as challenging task. From methods for the epidemiology of Child and Adolescent Mental Disorders (MECA) study, it was revealed that children receiving less medication than mental health counseling and school based interventions would be at risk. Hence, this study urges the education of parents, physicians and health professionals to understand the efficacy of the treatment strategies (Jensen et al., 1999).
Earlier study described that there was poor attention on the prevalence of DSM- IV ADHD and is emphasizing on more number of population based studies in order to better understand the treatment patterns in community settings and the etiology of this disease (Rowland et al., 2001).
Kadesjö et al. (2003) conducted a study and reported that ADHD is associated with oppositional defiant disorder (ODD) and indicated that children with symptoms of both the disorders should be assessed by parent training and network support.
Although ADHD prevalence is reported in children, it is essential to know about the gender predisposition to symptoms to better characterize the disease. Therefore a study reported that ADHD is helpful in predicting the symptoms of anxiety and depression during early adolescence in girls than in boys. (Lahey et al., 2007).
As ADHD children face problems in the society, they need specific intervention programs at an earlier stage. Hence, taiwanese researchers have taken initiative to conduct parent training with the objective of reducing the ADHD combined with ODD symptoms Huang et al., (2003).
Chang et al. (2004) conducted a study and reported that social skills training program improved the childrens behavior which could easily help them to overcome the difficulties in regulating their emotions and maintaining good peer relations.
With the advancements made in modern biology, new strategies have been worked out to gain further insights about ADHD. Gene polymorphism studies have entered to reveal the association of various genes with ADHD. Previously, animal studies were conducted to describe the relationship between candidate gene and a behavior trait in dogs to better understand the role of DRD4 exon 3 polymorphism in the etiology of ADHD (Hejjas et al. 2007).
Shaw et al.(2007) showed that a polymorphism in DRD4 7-repeat allele is associated with cortical thinning in regions essential for attention control. Further environment and gene- environment interactions were also considered as potential risk factors in the pathogenesis of ADHD (Banerjee et al. 2007). This study seems to be vital as ADHD children need better adjustment to the environment.
Hence ADHD disorder is having strong link with genetic factors.
To further strengthen the role of environment and for an effective control of incidence or severity of this disorder, it is central to consider the ecological aspects. Bernfort et al.(2008) highlighted in a study that ADHD children’s ability in a particular environment is likely to put them at risk that would persist in adulthood. The mentioned problems are employment status, health care, consumption, traffic, accidents and criminality.
Hence, keeping in view of the problems, following research would be likely carried out. Initially, it is vital to understand the influence of ADHD on society. Prevalence rates of ADHD in different countries have to be taken into account. Large pool of samples needs to be considered from different schools for a convincing data. Intervention programs would be set up to investigate the incidence of ADHD.Parents would be primarily targeted followed by teachers and primary care organizers in the intervention programs.
Children will be screened and selected as per the guidelines of APA. Children would be assessed by monitoring their diet preferences and given appropriate counseling under the parent supervision. A thorough analysis of tissue levels of micronutrients and fatty acids should be effectively carried out to manage the disease.
C-vitamin and iron deficient children will have to be identified at an earlier stage and studied for associated symptoms to predict the severity of the disease. If essential, they need to be supplemented with the required nutrient rich diet. Trained teachers are asked to provide feedback about the behavior patterns and variations in environmental perception exhibited by ADHD children. Teachers should be also approached to give other details like depression, and aggressiveness of children. As academic performance is another key factor, ADHD children have to be given special attention and care to avoid discouragement. Further, ADHD children should be kept under surveillance against any kind of substance use disorders (SUD).
Children need to be regularly allowed to visit any peaceful atmosphere accompanied by teacher and open air class system is followed to achieve mental stability. This process if continued for a quite long period would improve the health of ADHD children. It is imperative that children are sent to primary care centers for periodic check ups to diagnose other health complaints like recurrent abdominal pain (RAP), sleeping problems and tiredness.
Large experiments on animal models need to be conducted to identify potential candidate genes for ADHD.
Genotyping of human subjects of different regions has to be carried out to determine the gene environment predisposition and whether this disease is confined to one particular genetic population. This information would also reveal homogeneity or heterogeneity of children with ADHD.
ADHD children would be exposed to different environmental conditions and genes are screened and checked to determine up regulation or downregulation.
It can be inferred that the genomic information would better help to alleviate ADHD, for example by gene therapy. Existing treatment would be evaluated for possible side effects and new drugs would be designed based on the information obtained from patient-drug interaction. Proteomic analysis of ADHD children would furnish better insights on the pathogenesis and hence large number of studies would be conducted. Environmental factors suspicious of posing a threat would be identified and studied.
Conclusions
On the whole, ADHD is one of the severe mental illnesses identified so far. Children below 12 years of age are the likely candidates and this problem would continue until adolescence stage. Research has been in progress since long time to better diagnose this disease as per DSM IV criteria and APA guidelines.
Prevalence studies conducted in different countries have been almost matching with one another. Social training or intervention programs consisting of parents and teachers proved to be mandatory and beneficial. Academic progress, behavior patterns and associated health complaints needed significant attention. A close watch on the association between ADHD and SUD may be helpful. Similarly, the association between ADHD and ODD requires awareness. Some of the environmental conditions have risk implications. Nutritional factors such as zinc, vitamin C, and iron have been considered as the most essential supplementations for improving the health.
Modern biological techniques like genotyping may help in better understanding of the genetic predisposition to various environmental conditions and identifying the candidate genes. Proteomic analysis if coupled could be an added advantage. New therapeutic tools have to be tested by employing large number of animal studies.
Although, significant number of studies have furnished valuable information in lessening the severity of ADHD, there is still some scarcity in totally preventing this disorder.
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