Attention Deficit Hyperactivity Disorder( Hyperkinetic Disorder)

Someone thinks that this is just a character, someone will consider it a wrong education, but many doctors call it attention deficit hyperactivity syndrome. Attention Deficit Hyperactivity Disorder( ADHD) is a dysfunction of the central nervous system( mainly the reticular formation of the brain), manifested by difficulty concentrating and maintaining attention, learning and memory disabilities, and difficulties in processing exogenous and endogenous information and stimuli. This is one of the most common neuropsychiatric disorders in childhood, its prevalence ranges from 2 to 12%( an average of 3-7%), is more common in boys than in girls. ADHD can occur both in an isolated form, and in combination with other emotional and behavioral disorders, adversely affecting the learning and social adaptation of the child.

The first manifestations of ADHD are usually observed from 3-4 years of age. But when a child gets older and goes to school, he has additional difficulties, since the beginning of schooling introduces new, higher requirements for the child's personality and his intellectual abilities. It is during school days that violations of attention become evident, as well as difficulties in mastering the school curriculum and poor academic performance, self-doubt and low self-esteem.

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Children with attention deficit disorder have normal or high intelligence, but, as a rule, they do not go to school well. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, attention deficit, distractibility, impulsive behavior, problems in relationships with others. In addition to the fact that children with ADHD behave badly and have poor schooling, becoming older, they can be at risk of developing deviant and antisocial behaviors, alcoholism, and drug addiction. Therefore it is important to recognize the early manifestations of ADHD and to know about the possibilities of their treatment. It should be noted that attention deficit disorder is observed in both children and adults.

Causes of ADHD

Reliable and the only cause of the syndrome has not yet been found. It is believed that the formation of ADHD is based on neurobiological factors: genetic mechanisms and early organic damage to the central nervous system, which can be combined with each other. They determine the changes from the side of the central nervous system, the violation of higher mental functions and behavior, corresponding to the picture of ADHD.The results of modern studies indicate the involvement of the "associative cortex-basal ganglion-thalamus-cerebellum-prefrontal cortex" system in the pathogenetic mechanisms of ADHD, in which the coordinated functioning of all structures ensures control of attention and organization of behavior.

In many cases, the additional impact on children with ADHD has negative socio-psychological factors( primarily intrafamily), which in themselves do not cause development of ADHD, but always contribute to increasing the child's symptoms and adaptation difficulties.

Genetic mechanisms. Among the genes that determine the predisposition to the development of ADHD( the role of some of them in the pathogenesis of ADHD is confirmed, and others are considered as candidates), the genes governing the exchange of neurotransmitters in the brain, in particular dopamine and norepinephrine. Dysfunction of the neurotransmitter systems of the brain plays an important role in the pathogenesis of ADHD.At the same time, the most important are the violations of the processes of synaptic transmission, which entail disconnection, a break in the connections between the frontal lobes and subcortical formations and, as a consequence, the development of symptoms of ADHD.In favor of disorders of the neurotransmitter transmission of systems as a primary link in the development of ADHD, the mechanisms of action of drugs most effective in the treatment of ADHD are to activate the release and inhibition of the reuptake of dopamine and norepinephrine in the presynaptic nerve endings, which increases the bioavailability of neurotransmitters at the level of synapses.

In modern concepts, attention deficit in children with ADHD is seen as a result of disturbances in the work of the cerebrospinal attention system regulated by norepinephrine, whereas behavioral inhibition and self-control disorders characteristic of ADHD are like a failure of dopaminergic control of impulses to the anterior cerebral system of attention. The posterior cerebral system includes the upper parietal cortex, the upper dystocia, the cushion of the thalamus( dominant in this case belongs to the right hemisphere);this system receives a dense noradrenergic innervation from the locus coeruleus( blue spot).Norepinephrine suppresses spontaneous discharges of neurons, thus the posterior cerebral attention system, which is responsible for targeting new stimuli, is prepared to work with them. This is followed by a switch of attention mechanisms to the anterior cerebral control system, which includes the prefrontal cortex and the anterior part of the cingulate gyrus. The susceptibility of these structures to incoming signals is modulated by dopaminergic innervation from the ventral core of the midbrain. Dopamine selectively regulates and limits the exciting impulses to the prefrontal cortex and cingulate gyrus, ensuring a reduction in excessive neuronal activity.

Attention Deficit Hyperactivity Disorder is considered to be a polygenic disorder, in which simultaneously existing numerous disturbances in the metabolism of dopamine and / or norepinephrine are caused by the effects of several genes overlapping the protective action of compensatory mechanisms. Effects of genes that cause ADHD are complementary. Thus, ADHD is seen as a polygenic pathology with a complex and variable inheritance, and at the same time as a genetically heterogeneous state.

The pre- and perinatal factors of play an important role in the pathogenesis of ADHD.The formation of ADHD can be preceded by abnormalities in pregnancy and childbirth, particularly gestosis, eclampsia, the first pregnancy, the age of the mother under 20 or over 40, prolonged delivery, premature pregnancy and prematurity, low birth weight, morphofunctional immaturity, hypoxicischemic encephalopathy, a child's disease in the first year of life. Other risk factors are the use of certain drugs, alcohol and smoking during pregnancy.

Apparently, with the early damage of the central nervous system, a slight decrease in the size of the prefrontal regions of the brain( mainly in the right hemisphere), subcortical structures, corpus callosum, cerebellum is found in children with ADHD compared with healthy peers by means of magnetic resonance imaging( MRI).These data support the concept that the appearance of symptoms of ADHD is due to impaired connections between the prefrontal and subcortical nodes, primarily the caudate nucleus. In the future, additional confirmation was obtained through the use of methods of functional neuroimaging. Thus, in the determination of cerebral blood flow by the method of single-photon emission computed tomography in children with ADHD, a decrease in the blood flow( and, consequently, metabolism) in the frontal lobes, subcortical nuclei and the middle brain was demonstrated in comparison with healthy peers, with the most pronounced changes at the levelcaudate nucleus. According to the researchers, changes in the caudate nucleus in children with ADHD were the result of its hypoxic-ischemic injury in the period of newborn. Having close connections with the visual tubercle, the caudate nucleus performs an important function of modulation( predominantly inhibitory) of polysensory impulses, and the absence of inhibition of polysensory impulses can be one of the pathogenetic mechanisms of ADHD.

With the help of positron emission tomography( PET) it was found that the brain ischemia transmitted at birth leads to persistent changes of dopamine receptors of the 2 nd and 3 rd types in striatum structures. As a result, the ability of receptors to bind dopamine is reduced and the functional deficiency of the dopaminergic system is formed.

A recent comparative MRI study of children with ADHD, whose goal was to assess regional differences in the thickness of the cerebral cortex and compare their age dynamics with clinical outcomes, showed that children with ADHD exhibited a global decrease in the thickness of the cortex, most pronounced in the prefrontal( medial and upper)and precentral departments. In patients with worse clinical outcomes, the primary examination revealed the smallest thickness of the cortex in the left medial prefrontal region. Normalization of the thickness of the right parietal cortex was accompanied by the best outcomes in patients with ADHD and may reflect a compensatory mechanism associated with changes in the thickness of the cerebral cortex.

Neuropsychological mechanisms of ADHD are considered from positions of immaturity of functions of the frontal lobes of the brain, primarily the prefrontal region. The manifestations of ADHD are analyzed from the standpoint of a deficiency in the functions of the frontal and prefrontal parts of the brain and the insufficient formation of control functions( UV).Patients with ADHD detect "control dysfunction".The development of UV and the maturation of the prefrontal region of the brain are long processes that continue not only in childhood but also in adolescence. UV is a fairly broad concept related to the range of abilities that serve the task of maintaining the necessary sequence of efforts to solve a problem aimed at achieving a future goal. Significant components of UV, which suffer from ADHD, are: impulse control, behavioral inhibition( containment);organization, planning, management of mental processes;maintenance of attention, deterrence from distractions;inner speech;operational( operative) memory;anticipation, forecasting, looking to the future;retrospective evaluation of past events, mistakes made;change, flexibility, ability to switch and review plans;choice of priorities, ability to distribute time;separation of emotions from real facts. Some UV researchers emphasize the "hot" social aspect of self-regulation and the child's ability to control his behavior in society, while others emphasize the role of the regulation of mental processes - the "cold" cognitive aspect of self-regulation.

Influence of adverse environmental factors. Anthropogenic pollution of the environment of the natural environment, largely associated with microelements from the heavy metal group, can have negative consequences for children's health. It is known that in the immediate vicinity of many industrial enterprises zones with an increased content of lead, arsenic, mercury, cadmium, nickel and other microelements are formed. The most common neurotoxicant from the group of heavy metals is lead, and sources of environmental contamination are industrial emissions and vehicle exhaust. The intake of lead in children can cause cognitive and behavioral disorders in children.

The role of nutritional factors and unbalanced nutrition. Symptoms of ADHD may be caused by imbalance in nutrition( eg, protein deficiency with an increase in the amount of easily digestible carbohydrates, especially in the morning hours), and malnutrition in micronutrients, including vitamins, folates, omega-3 polyunsaturated fatty acids( PUFAs), macro- and microelements. Such micronutrients as magnesium, pyridoxine and some others directly affect the synthesis and degradation of monoamine neurotransmitters. Therefore, micronutrient deficiency can affect the neurotransmitter balance and, consequently, the manifestation of ADHD symptoms.
Magnesium is of particular interest among micronutrients, which is a natural lead antagonist and contributes to the rapid elimination of this toxic element. Therefore, magnesium deficiency, in addition to other effects, can contribute to the accumulation of lead in the body.

Magnesium deficiency in ADHD can be associated not only with its insufficient intake into the body with food, but also with an increased need for it during critical periods of growth and development, with severe physical and neuropsychic loads, stress. Under environmental conditions, nickel and cadmium act as magnesium displacing metals along with lead. In addition to the lack of magnesium in the manifestation of symptoms of ADHD may affect the deficiencies of zinc, iodine, iron.

Thus, ADHD is a complex neuropsychiatric disorder accompanied by structural, metabolic, neurochemical, neurophysiological changes in the CNS, as well as neuropsychological disturbances from the processing of information and UV.

Symptoms of ADHD in children

Symptoms of ADHD in a child can be a reason for a primary treatment for pediatricians, speech therapists, defectologists, psychologists. Often the teachers of preschool and school educational institutions pay attention to the symptoms of ADHD for the first time, and not parents. The detection of such symptoms is an occasion to show the child to a neurologist and neuropsychologist.

Main manifestations of ADHD

1. Attention violations
Does not hold attention to details, allows many mistakes.
Hardly keeps attention while doing school and other tasks.
Does not listen to the speech addressed to him.
Can not adhere to instructions and get things done.
Not able to plan and organize tasks independently.
Avoids cases requiring prolonged mental stress.
Often loses his things.
Easily distracted.
Is forgetful.
2a. Hyperactivity
Often makes restless movements with arms and legs, fidgets in place.
Can not sit still when needed.
Often runs or gets somewhere when it's inappropriate.
Can not play quietly, quietly.
Excessive aimless motor activity is of a persistent nature, it is not affected by the rules and conditions of the situation.
2b. Impulsivity
Responds to questions without listening to the end and without hesitation.
Can not wait its turn.
Hinders other people, interrupts them.
Mullet, incoherent in speech.

Obligatory characteristics of ADHD are:

- duration: symptoms are noted for at least 6 months;
- constancy, spreading to all spheres of life: adaptation disorders are observed in two or more types of environment;
- severity of violations: significant violations in training, social contacts, professional activities;
- other mental disorders are excluded: the symptoms can not be related solely to the course of another disease.

Depending on the prevailing symptoms, there are 3 forms of ADHD:
- combined( combined) form - there are all three groups of symptoms( 50-75%);
- ADHD with predominant attention impairment( 20-30%);
- ADHD with a predominance of hyperactivity and impulsivity( about 15%).

Symptoms of ADHD have their own characteristics in preschool, junior school and adolescence.

Preschool age. At the age of 3 to 7 years, hyperactivity and impulsiveness usually begin to manifest. Hyperactivity is characterized by the fact that the child is in constant movement, can not sit still quietly during class for a short time, is too talkative and asks an infinite number of questions. Impulsiveness is expressed in the fact that he acts without thinking, can not wait his turn, does not feel constraints in interpersonal communication, interfering in conversations and often interrupting others. Such children are often characterized as unable to behave or too temperamental. They are extremely impatient, arguing, making noise, shouting, which often leads them to outbursts of intense irritation. Impulsivity can be accompanied by recklessness, as a result of which the child endangers himself( increased risk of injury) or others. During games, energy hits the edge, and therefore the games themselves become destructive. Children are sloppy, often abandon, break things or toys, disobedient, poorly obey the requirements of adults, can display aggressiveness. Many hyperactive children lag behind peers in the development of speech.

School age. After entering the school, the problems of children with ADHD increase significantly. The training requirements are such that a child with ADHD is not able to fulfill them fully. Since his behavior does not correspond to the age norm, in school he does not manage to achieve the results corresponding to his abilities( at the same time the general level of intellectual development in children with ADHD corresponds to the age range).During the lessons they do not hear the teacher, they find it difficult to cope with the proposed tasks, because they have difficulties in organizing the work and bringing it to the end, forget the terms of the assignment as they go through, poorly learn the teaching materials and can not apply them correctly. They pretty soon get out of the work process, even if they have everything they need, do not pay attention to the details, show forgetfulness, do not follow the instructor's instructions, switch badly when the conditions of the job change or are given a new one. Can not independently cope with the performance of lessons at home. Compared with peers, difficulties in the formation of writing, reading, counting, logical thinking skills are more often observed.

Problems in relationships with others, including peers, teachers, parents, brothers and sisters, are constantly found in children with ADHD.Since all manifestations of ADHD are characterized by significant mood swings in different periods of time and in different situations, the child's behavior is unpredictable. Often there are temper tantrums, bullying, oppositional and aggressive behavior. As a result, he can not play for a long time, successfully communicate and establish friendly relations with peers. In the team he serves as a source of constant anxiety: he makes noisy, takes no thought, takes other people's things, hinders others. All this leads to conflicts, and the child becomes unwanted and rejected in the team.

When faced with this attitude, children with ADHD often consciously choose the role of a class jester, hoping to establish relationships with their peers. A child with ADHD not only learns badly himself, but often "breaks" lessons, interferes with the work of the class and is therefore often summoned to the director's office. In general, his behavior creates the impression of "immaturity", inconsistency with his age. Communicate with him are usually ready only for children younger in age or peers with similar behavior problems. Gradually, children with ADHD develop low self-esteem.

At home, children with ADHD usually suffer from constant comparisons with brothers and sisters who behave well and learn better. Parents are annoyed that they are restless, intrusive, emotionally labile, undisciplined, disobedient. At home, the child is unable to respond responsibly to the performance of daily tasks, does not help parents, is inaccurate. At the same time, remarks and punishments do not give the desired results. According to the parents, "Something always happens to him," that is, there is an increased risk of injuries and accidents.

Adolescence. In adolescence, severe symptoms of impaired attention and impulsiveness continue to be observed in at least 50-80% of children with ADHD.In this case, hyperactivity in adolescents with ADHD is significantly reduced, replaced by fussiness, a sense of inner anxiety. They are characterized by lack of independence, irresponsibility, difficulties in organizing and completing assignments and especially long-term work, which they are often unable to cope without outside help. School performance is often deteriorating, as they can not effectively plan their work and distribute it over time, postpone the day-to-day execution of necessary cases.

There are growing difficulties in relationships in the family and school, behavioral disorders. Many adolescents with ADHD are characterized by reckless behavior associated with unjustified risk, difficulties in observing the rules of conduct, non-compliance with social norms and laws, failure to meet the requirements of adults-not only parents and educators, but also officials, for example representatives of the school administration or police. At the same time, they are characterized by weak psycho-emotional stability in case of failures, self-doubt, low self-esteem. They are too sensitive to teasing and ridicule by peers who consider them stupid. The surrounding people still characterize the behavior of adolescents with ADHD as immature, not age-appropriate. In everyday life, they neglect necessary safety measures, which increases the risk of injuries and accidents.

Adolescents with ADHD tend to be involved in adolescent groups that commit various offenses, they may have a craving for alcohol and drugs. But in these cases, as a rule, they are guided, subject to the will of stronger peers or persons older than themselves and without thinking about the possible consequences of their actions.

Disorders associated with ADHD( comorbid disorders). Additional complications of intrafamily, school and social adaptation in children with ADHD may be associated with the formation of concomitant disorders that develop against ADHD as a major disease in at least 70% of patients. The presence of comorbid disorders can lead to a weighting of clinical manifestations of ADHD, worsening of the long-term prognosis and a decrease in the effectiveness of treatment for ADHD.Concomitant ADHD behavioral disorders and emotional disorders are considered as unfavorable prognostic factors for the long, up to chronic, course of ADHD.

Comorbid disorders with ADHD are represented by the following groups: externalized( opposition-causing disorder, behavioral disorder), internalized( anxiety disorders, mood disorders), cognitive disorders( speech development disorders, specific learning difficulties - dyslexia, dysgraphia, dyscalculia), motor( static-locomotor insufficiency, dyspraxia development, tics).Other ADHD related disorders may include sleep disorders( parasomnia), enuresis, encopresis.

Thus, learning, behavior and emotional problems can be related to both the direct influence of ADHD and comorbid disorders, which must be diagnosed in a timely manner and considered as an indication for the additional purpose of the appropriate treatment.

Diagnosis of ADDD

In Russia, the diagnosis of "hyperkinetic disorder" is roughly equivalent to the combined form of ADHD.To diagnose all three groups of symptoms should be confirmed( table above), including at least 6 manifestations of inattention, at least 3 - hyperactivity, at least 1 - impulsiveness.

There are no specific criteria or tests based on the use of modern psychological, neurophysiological, biochemical, molecular genetic, neuroradiologic and other methods to confirm ADHD.The diagnosis of ADHD is made by a doctor, but educators and psychologists should also be well acquainted with the diagnostic criteria of ADHD, all the more so to confirm this diagnosis it is important to obtain reliable information about the child's behavior not only at home, but at school or preschool.

In childhood, the states-"imitators" of ADHD are quite common: in 15-20% of children, forms of behavior that are outwardly similar to ADHD are observed periodically. In connection with this, ADHD must be distinguished from a wide range of conditions, similar to it only by external manifestations, but substantially different both for reasons and methods of correction. These include:

- individual characteristics of personality and temperament: the behavior characteristics of active children do not exceed the age limit, the level of development of higher mental functions is good;
- anxiety disorders: the characteristics of the child's behavior are associated with the effect of psychotraumatic factors;
- consequences of the suffered craniocerebral trauma, neuroinfection, intoxication;
- asthenic syndrome in somatic diseases;
- Specific disorders of development of school skills: dyslexia, dysgraphia, dyscalculia;
- endocrine diseases( pathology of the thyroid gland, diabetes mellitus);
- sensorineural hearing loss;
- epilepsy( absence forms, symptomatic, locally caused forms, side effects of anti-epileptic therapy);
- hereditary syndromes: Tourette, Williams, Smith-Mazenis, Beckwith-Wiedemann, breaking of the X-chromosome;
- mental disorders: autism, affective disorders( moods), mental retardation, schizophrenia.

In addition, the diagnosis of ADHD should be based on the peculiar age dynamics of this condition.

Treatment of ADHD

At the present stage, it becomes clear that the treatment of ADHD should be directed not only to the control and reduction of the main manifestations of the disorder, but also to the solution of other important tasks: improving the patient's functioning in various fields and its fullest implementation as a person, the appearance of own achievements, improvementself-evaluation, normalization of the situation around him, including within the family, the formation and strengthening of communication skills and contacts with surrounding people, recognition of others and increased satisfactionNost their lives.

The study confirmed a significant negative impact of the difficulties experienced by children with ADHD, on their emotional state, life in the family, friendships, schooling, leisure activities. In this regard, the concept of an expanded therapeutic approach is formulated, implying the spread of the effect of treatment beyond the reduction of the main symptoms and taking into account functional outcomes and quality of life indicators. Thus, the concept of an expanded therapeutic approach involves addressing the social and emotional needs of a child with ADHD, which should be given special attention both at the stage of diagnosis and treatment planning, and in the process of dynamic observation of the child and evaluation of the results of the therapy.

The most effective in ADHD is comprehensive care, which combines the efforts of doctors, psychologists, teachers working with the child, and his family. The treatment of ADHD should be timely and must include:

- help the child's family with ADHD - family and behavioral therapy techniques that provide the best interaction in the families of children suffering from ADHD;
- development of parenting skills in children with ADHD, including parent training programs;
- educational work with teachers, correction of the school curriculum - through special - the supply of educational material and the creation of such an atmosphere in a lesson that maximizes the opportunities for successful learning of children;
- psychotherapy of children and adolescents with ADHD, overcoming difficulties, formation of effective communication skills in children with ADHD during special corrective sessions;
is a drug therapy that should be long enough, as the improvement of the condition extends not only to the main symptoms of ADHD, but also to the socio-psychological side of patients' lives, including their self-esteem, relationships with family members and peers, usually starting from the third month of treatment. Therefore, it is advisable to plan drug therapy for several months up to the duration of the entire school year.

An effective drug specially developed for the treatment of ADHD is atomoxetine hydrochloride .The main mechanism of its action is associated with the blockade of norepinephrine reuptake, which is accompanied by an increase in synaptic transmission involving norepinephrine in different brain structures. In addition, in experimental studies, an increase in the content of not only norepinephrine but also dopamine in the prefrontal cortex was observed under the influence of atomoxetine, since dopamine binds to the same transport protein as norepinephrine in this region. Since the prefrontal cortex plays a leading role in providing the control functions of the brain, as well as attention and memory, an increase in the concentration of noradrenaline and dopamine in this area under the action of atomoxetine leads to a weakening of ADHD manifestations. Atomoxetine has a beneficial effect on behavioral characteristics of children and adolescents with ADHD, its positive effect is usually manifested at the beginning of treatment, but the effect continues to increase within a month of continuous intake of the drug. In most patients with ADHD, clinical efficacy is achieved when the drug is administered at a dose range of 1.0-1.5 mg / kg body weight per day with a single dose in the morning. The advantage of atomoxetine is its effectiveness in cases of combination of ADHD with destructive behavior, anxiety disorders, tics, enuresis. The drug has many side effects, so the reception is strictly under the supervision of the doctor.

Russian specialists in the treatment of ADHD traditionally use drugs nootropic series .Their use in ADHD is justified, since nootropic drugs have a stimulating effect on the cognitive functions( attention, memory, organization, programming and control of mental activity, speech, praxis) that are not sufficiently formed in the children of this group. In view of this circumstance, one should not take the positive effect of drugs with stimulating action as paradoxical( taking into account the children's hyperactivity).On the contrary, the high effectiveness of nootropics seems to be logical, especially since hyperactivity is only one of the manifestations of ADHD and is itself caused by impairments on the part of higher mental functions. In addition, these drugs have a positive effect on metabolic processes in the central nervous system and promote the maturation of inhibitory and regulatory systems of the brain.

A recent study has confirmed the good potential of for the preparation of gopantenic acid in the long-term treatment of ADHD.Positive effect on the main symptoms of ADHD is achieved already after 2 months of treatment, but continues to intensify after 4 and 6 months of its use. Along with this, the favorable effect of long-term use of the drug gopantenic acid on the characteristic for children with ADHD disorders of adaptation and functioning in various fields, including the difficulties of behavior in the family and in society, schooling, the reduction of self-esteem, and the lack of basic life skills. However, in contrast to the regression of the main symptoms of ADHD, longer treatment periods were required to overcome adaptation disruptions and socio-psychological functioning: a significant improvement in self-esteem, communication with others and social activity was observed following the parents' questionnaire after 4 months, and a reliable improvement in the behavior andschooling, basic life skills, along with a significant regression of risk-related behavior - after 6 months of application of the drug gopantenic acidyou.

Another area of ADHD treatment is the control of negative nutritional and environmental factors that lead to the entry of neurotoxic xenobiotics( lead, pesticides, polyhaloalkyls, food colorings, preservatives) into the child's body. This should be accompanied by the inclusion in the diet of the necessary micronutrients, which help reduce the symptoms of ADHD: vitamins and vitamin-like substances( omega-3 PUFAs, folates, carnitine) and essential macro- and microelements( magnesium, zinc, iron).
Micronutrients with a confirmed clinical effect for ADHD should be noted for magnesium preparations. Deficiency of magnesium is defined in 70% of children with ADHD.

Magnesium is an important element involved in maintaining the balance of excitation and inhibition processes in the central nervous system. There are several molecular mechanisms through which magnesium deficiency affects the activity of neurons and the metabolism of neurotransmitters: magnesium is necessary for stabilizing the excitatory( glutamate) receptors;magnesium - an essential cofactor of adenylate cyclases involved in signaling from neurotransmitter receptors to intracellular cascade control;Magnesium is a co-agent of catechol-O-methyltransferase inactivating the excess of monoamine neurotransmitters. Therefore, a deficiency of magnesium contributes to an imbalance of the processes of "excitation-inhibition" in the central nervous system in the direction of excitation and can affect the manifestation of ADHD.

In the treatment of ADHD only organic salts of magnesium( lactate, pidolate, citrate) are used, which is due to the high bioavailability of organic salts and the absence of side effects when used in children. The use of magnesium pidolate with pyridoxine in solution( ampoule form of Magne B6 preparation( Sanofi-Aventis, France)) is allowed from the age of 1 year, lactate( Magne B6 in tablets) and magnesium citrate( Magne B6 forte in tablets) - from 6 years. Magnesium content in one ampoule is equivalent to 100 mg of ionized magnesium( Mg2 +), in one Magne B6 tablet - 48 mg of Mg2 +, in one Magne B6 forte tablet( 618.43 mg of magnesium citrate) - 100 mg of Mg2 +.The high concentration of Mg2 + in the preparation Magne B6 forte allows you to take 2 times less tablets than when taking Magne B6.The advantage of Magne B6 in ampoules is also the possibility of more accurate dosing, the use of ampoule form Magne B6 provides a rapid increase in the level of magnesium in blood plasma( for 2-3 hours), which is important for the rapid elimination of magnesium deficiency. At the same time, taking Magne B6 tablets promotes a longer( for 6-8 hours) retention of increased magnesium concentration in erythrocytes, that is, its deposition.

The advent of combined preparations containing magnesium and vitamin B6( pyridoxine), significantly improved the pharmacological properties of magnesium salts. Pyridoxine is involved in the metabolism of proteins, carbohydrates, fatty acids, the synthesis of neurotransmitters and many enzymes, has neuro-, cardio-, hepatotropic, and hematopoietic influence, contributes to the replenishment of energy resources. The high activity of the combined preparation is due to the synergism of the action of the components: pyridoxine increases the magnesium concentration in plasma and red blood cells and reduces the amount of magnesium withdrawn from the body, improves absorption of magnesium in the gastrointestinal tract, its penetration into cells, and fixation. Magnesium, in turn, activates the process of transformation of pyridoxine into its active metabolite pyridoxal-5-phosphate in the liver. Thus, magnesium and pyridoxine potentiate the action of each other, which makes it possible to successfully use their combination to normalize the magnesium balance and prevent the lack of magnesium.

Combined intake of magnesium and pyridoxine for 1-6 months reduces the symptoms of ADHD and restores normal magnesium values in erythrocytes. Already after one month of treatment, anxiety, attention deficit disorder and hyperactivity decrease, concentration of attention, accuracy and speed of tasks fulfillment improves, the number of errors decreases. There is an improvement in large and small motility, a positive dynamics of EEG characteristics in the form of disappearance of signs of paroxysmal activity against the background of hyperventilation, as well as bilateral-synchronous and focal pathological activity in the majority of patients. Simultaneously reception of Magne B6 is accompanied by normalization of magnesium concentration in erythrocytes and blood plasma of patients.

Replenishment of magnesium deficiency should last at least two months. Given that the alimentary deficiency of magnesium is most common, in the preparation of recommendations for nutrition should take into account not only the quantitative content of magnesium in products, but also its bioavailability. So, fresh vegetables, fruits, herbs( parsley, dill, green onions) and nuts have the maximum concentration and activity of magnesium. When storing products for storage( drying, canning), the magnesium concentration decreases slightly, but its bioavailability drops sharply. This is important for children with ADHD who have a deepening magnesium deficiency that coincides with the period of schooling from September to May. Therefore, the use of combined preparations containing magnesium and pyridoxine, is advisable during the school year.

Thus, early detection of ADHD in children will prevent problems with learning and behavior in the future. Development and application of complex correction should be carried out in a timely manner, be individual. Treatment of ADHD, including drug therapy, should be long enough.

Forecast for ADHD

The prognosis is relatively favorable, for a significant part of children even without treatment the symptoms disappear in adolescence. Gradually, as the child grows, disturbances in the neurotransmitter system of the brain are compensated, and some of the symptoms regress. However, clinical manifestations of attention deficit hyperactivity disorder( excessive impulsiveness, short temper, absent-mindedness, forgetfulness, restlessness, impatience, unpredictable, rapid and frequent mood changes) can also be observed in adults.

The factors of unfavorable prognosis of the syndrome are its combination with mental illnesses, the presence of mental pathology in the mother, as well as the symptoms of impulsiveness in the patient himself. Social adaptation of children with attention deficit hyperactivity disorder can only be achieved if the family and school are interested and cooperating.

NNZavadenko