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1. INTRODUCTION
Mental health can affect daily life, relationships and even physical health. It
includes our emotional, psychological and social well-being. Anyhow mental disorders majorly
affect to break down our mental stability and it badly connects with our mental health.
Therefore, first of all, it is necessary to identify what is a mental disorder.
DEFINING A MENTAL DISORDER
According to the DSM-5,
“A mental disorder is a syndrome characterized by a clinically significant
disturbance in an individual’s cognition, emotion, regulation or behaviour that reflects a
dysfunction in the psychological, biological or developmental processes underlying mental
functioning. Mental disorders are usually associated with significant distress or disability in
social, occupational or other important activities. An expectable or culturally approved
response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.
Socially deviant behaviour (e.g. political, religious or sexual) and conflicts that are primarily
between the individual and society are not mental disorders unless the deviance or conflict
results from a dysfunction in the individual”1
.
Mental disorders among children are described as child mental disorders. It is
important to recognize and treat mental illnesses in children early on. If untreated, those mental
conditions severely influence children’s development. And children with mental disorders face
major challenges with stigma, isolation and discrimination. Mental disorders can emerge with
the growth and development of the brain or
central nervous system of the child. Some
mental illnesses are common childhood
mental disorders.
1
DSM – 5, page 20

2. CLASSIFICATION OF CHILD MENTAL DISORDERS
Neurodevelopmental Disorders
Neurodevelopmental disorders manifest early in development with the growth of
the brain of the child. More often before the child enters grade school, is characterized by
developmental deficits that produce impairments of personal, social, academic or occupational
functioning. We can recognize several child mental disorders under the subject of
neurodevelopmental disorders as follows;
 Intellectual disabilities
 Communication disorders
 Language disorder
 Speech and sound disorder
 Childhood-onset fluency disorder (Stuttering)
 Social communication disorder
 Autism spectrum disorder
 Attention deficit / hyperactivity disorder
 Specific learning disorder
 Motor disorders
 Developmental coordination disorder
 Stereotypic movement disorder
 Tic disorders
Bipolar and Related Disorders
According to the DSM-5, many individuals particularly children experience and
related disorders.
 Bipolar I disorder
When the children are in the major depressive episode of the bipolar I disorder, they can be in
the irritable mood most of the day and they fail to make expected weight gain.
 Cyclothymic disorder
Most children with cyclothymic disorder treated in outpatient psychiatric settings have
comorbid other mental conditions.

3. Depressive Disorders
According to DSM-5 children with this symptom pattern typically develop unipolar depressive
disorders. A more chronic form of the persistent depressive disorder can be diagnosed when
the mood disturbance continues for at least one year in children.
 Disruptive mood dysregulation disorder
This disorder is common among children and most of the children who suffer from this disorder
are male.
 Major depressive disorder
 Persistence depressive disorder
Anxiety Disorders
Many of the anxiety disorders develop in childhood and tend to persist if not treated.
 Separation anxiety disorder
 Selective mutism
 Specific phobia
 Social anxiety disorder
-In children, this anxiety disorder must occur in peer settings and not
just during interactions with adults.
 Generalized anxiety disorder
Trauma and Stressor-Related Disorders
 Reactive attachment disorder
 Disinhibited social engagement disorder
 A pattern of behaviour in which a child activity approaches with
unfamiliar adults and exhibits
 Posttraumatic stress disorder
 This disorder applies to children who are older than 6 years.

4. Elimination Disorders
Elimination disorders usually first diagnosed in childhood or adolescence.
 Enuresis
 Encopresis
Parasomnias
 Non rapid eye movement sleep arousal disorders
 Nightmare disorder
Disruptive Impulse – Control and Conduct Disorders
 Conduct disorder
Children with conduct disorder often have a pattern, beginning before 13 years.

5. ATTENTION – DEFICIT / HYPERACTIVITY DISORDER
Attention – deficit hyperactivity disorder (ADHD) is a mental disorder which comes
under the neurodevelopmental disorders. It is characterized by problems paying attention,
excessive activity or difficulty controlling behaviour which is not appropriate for a person’s
age. As with other behavioural and emotional problems of childhood, attention deficit disorder
is a descriptive term, not an etiologic diagnosis. It represents a final common pathway, the
outward manifestations of one or several influences upon the developing nervous system of the
child.
Hyperactivity is a term used to describe motor behaviour that is felt to be excessive
for age. To a certain degree, the use of the term hyperactive relates to the eye of the beholder.
Children virtually never identify themselves as such. Hyperactivity child running in and out of
the home to play will not excite much attention, but the same degree of motor activity.
Hyperactivity is commonly encountered as part of the syndrome of attention deficit
disorder. Attention deficit disorder can be diagnosed without hyperkinesis. The essential
features / stages of the attention deficit disorder are:-
 Inattention
 Impulsivity
 Hyperactivity2
In addition to these features, over-excitability, persistence and dysphoria are often associated.
One or two of the three major criteria will generally predominate in a child with attention deficit
disorder. Thus, hyperactivity may be much less prominent than impulsivity or inattentiveness.
When hyperactivity is a prominent symptom, the designation hyperkinetic
syndrome is used interchangeably with that of attention deficit
disorder, though the latter has the advantage of underscoring the
important role of attentional disturbance.3
2
Herskowitz Joel, Rosman Paul N, Pediatrics neurology and psychiatry common ground,
page 403-404
3
Herskowitz Joel, Rosman Paul N, Pediatrics neurology and psychiatry common ground,
page 403-404

6. DIAGNOSTIC CRITERIA OF ATTENTION-DEFICIT
HYPERACTIVITY DISORDER
1. A persistence pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development.
 Inattention
Six or more of the following symptoms have persisted for at least six months to a degree that
is inconsistent with developmental level and that negatively impacts directly on social and
academic activities.
 Often fails to give close attention to details or makes careless mistakes in school work,
at work or during other activities [e.g. overlooks or misses details, work is inaccurate]
 Often has difficulty sustaining attention in tasks or play activities.[e.g. has difficulty
remaining focused during lectures, conversations or lengthy reading]
 Often does not seem to listen when spoken to directly. [e.g. mind seems elsewhere
even in the absences of any obvious distraction]
 Often does not follow through on instructions and fails to finish schoolwork, chores or
duties in the workplace. [e.g. starts tasks but quickly loses focus and easily sidetracked]
 Often has difficulty organizing tasks and activities. [e.g. difficulty managing sequential
tasks, difficulty keeping materials and belongings in order, messy and disorganized
work, has poor time management, fails to meet deadlines]
 Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental
effort [ e.g. schoolwork or homework
 Often loses things necessary for tasks or activities[ e.g. school materials, pencils, books
tools, wallets, keys, paperwork, eyeglasses, mobile phones]
 Is often easily distracted by extraneous stimuli
 Is often forgetful in daily activities[ e.g. doing chores, running errands]4
4
DSM-5, page 59

7.  Hyperactivity and impulsivity
Six or more of the following symptoms have persisted for at least six months to a degree that
is inconsistent with developmental level and that negatively impacts directly on social and
academic activities.
 Often fidgets with or taps hands or feet or squirms in seat
 Often leaves the seat in situations when remaining seated is expected. [ leaves his or
her place in the classroom, in the office or another workplace]
 Often runs about or climbs in situations where it is inappropriate
 Often unable to play or engage in leisure activities quietly
 Is often “on the go” acting as if “driven by a motor”
 Often talks excessively
 Often blurts out an answer before a question has been completed
 Often has difficulty waiting for his or her turn[ e.g. while waiting in a line]
 Often interrupts or intrudes on others[ e.g. butts into conversations, games or activities]5
2. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12
years.
3. Several inattentive or hyperactive-impulsive symptoms are present in two or more
settings
4. There is clear evidence that the symptoms interfere with, or reduce the quality of, social
academic or occupational functioning.
5. The symptoms do not occur exclusively during the course of schizophrenia or another
psychotic disorder and are not better explained by another mental disorder[e.g. mood
disorder, anxiety disorder, personality disorder]6
5
DSM-5, page 60
6
DSM-5, page 60

8. DIAGNOSTIC FEATURES
1) The essential feature of attention deficit hyperactivity disorder (ADHD) is a persistent
pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning
or development
2) Inattention manifests behaviorally in ADHD as wandering off tasks, lacking
persistence, having difficulty sustaining focus, being disorganized and is not due to
defiance or lack of lack of comprehension.
3) Hyperactivity refers to excessive motor activity when it is not appropriate or excessive
fidgeting, tapping or talkativeness
4) In adults, hyperactivity may manifest as extreme restlessness or wear others out with
their activity.
5) Impulsivity refers to hasty actions that occur at the moment without forethought and
that have a high potential for harm to the individual.
6) Impulsivity may reflect a desire for immediate rewards or an inability to delay
gratification.
7) Impulsive behaviours may manifest as social intrusiveness (e.g. interrupting others
excessively) and/or as making important decisions without consideration of long-term
consequences.
8) Attention deficit hyperactivity disorder (ADHD) begins in childhood
9) Several symptoms are present before age 12 years and it conveys the importance of a
substantial clinical presentation during childhood.
10) Adult recall of childhood symptoms tend to be unreliable and it is beneficial to obtain
ancillary information.
11) Manifestations of the disorder must be present in more than one setting. [e.g. home,
school, work]

9. 12) Confirmation of substantial symptoms across settings typically cannot be accurate
without consulting informants who have seen the individual in those settings.
13) Typically, symptoms vary depending on the context within a given setting.
14) Signs of the disorder may be minimal or absent when ;
 the individual is receiving frequent rewards for appropriate behaviour
 under close supervision
 in a novel setting
 engaged in especially interesting activities
 has consistent external stimulation
 interacting in a one-on-one situation7
7
DSM-5,page 61

10. ASSOCIATED FEATURES SUPPORTING DIAGNOSIS
1) Mild delays in language, motor, or social development are not specific to ADHD but
often occur.
2) Associated features may include low frustration tolerance or irritability
3) Even in the absence of a specific learning disorder, academic or work performance is
often impaired
4) Inattentive behaviour is associated with various underlying cognitive processes and
individuals with ADHD may exhibit cognitive problems on tests of attention, executive
function or memory
5) No biological marker is diagnostic for ADHD.8
PREVALENCE OF THE DISORDER
 ADHD occurs in most cultures in about 5% of children and about 2.5% of adults.
GENDER-RELATED DIAGNOSTIC ISSUES
 ADHD is more frequent in males than in females in the general population with the
ratio of approximately 2:1 in children and 1.6:1 in adults. Females are more likely than
males to present primarily with inattentive features.
EXAMINING THE DISORDER
The hyperactivity child may be anything but that in a stimulus- poor, highly structured setting.
Generally, it can note the motoric activity of the child, whether increased or not. Some children
are able to sit calmly. Others fidget and have difficulty staying in their chairs. Still, others
manifest continuous, driven activity. They are out of the seat, under the desk, out of the door,
playing with the telephone, tugging at the window shade, opening and shuttering drawers. In
general acting impulsively and often provocatively.9
8
DSM-5, page 61
9
Herskowitz Joel, Rosman Paul N, Pediatrics neurology and psychiatry common ground,
page 407

11. DEVELOPMENT AND COURSE OF ATTENTION – DEFICIT
HYPERACTIVITY DISORDER
 Many parents first observe excessive motor activity when the child is a toddler, but
symptoms are difficult to distinguish from highly variable normative behaviours before
age 4 years.
 ADHD is most often identified during elementary school years and inattention becomes
more prominent and impairing.
 The disorder is relatively stable through early adolescence, but some individuals have
a worsened course with development with antisocial behaviours.
 Individuals with ADHD, symptoms of motoric hyperactivity become less obvious in
adolescence and adulthood, but difficulties with restlessness, inattention, poor planning
and impulsivity persist.
 A substantial proportion of children with ADHD remain relatively impaired into
adulthood.
 In preschool the main manifestation is hyperactivity.
 Inattention becomes more prominent during elementary school.
 During adolescence, signs of hyperactivity are less common and may be confined to
fidgetiness or inner feeling of jitteriness, restlessness or impatience.
 Inattention and restlessness and impulsivity may remain problematic even when
hyperactivity has diminished.

12. RISK AND PROGNOSTIC FACTORS OF ATTENTION - DEFICIT
HYPERACTIVITY DISORDER
Temperamental:-
ADHD is associated with reduced behavioural inhibition, effortful control or constraint;
negative emotionality and/or elevated novelty seeking. These traits may predispose some
children to ADHD but are not specific to the disorder.10
Environmental:-
Very low birth weight conveys a two to three-fold risk for ADHD, but most children with low
birth weight do not develop ADHD. Although ADHD is correlated with smoking during
pregnancy. A minority of cases may be related to reactions to aspects of diet. There may be a
history of child abuse, neglect, multiple foster placements, infections or alcohol exposure in
utero. Exposure to environmental toxicants has been correlated with subsequent ADHD. 11
Genetic and physiological:-
ADHD is elevated in the first degree biological relatives of individuals with ADHD. The
heritability of ADHD is substantial. While specific genes have been correlated with ADHD,
they are neither necessary nor sufficient causal factors. The possible influences on ADHD
symptoms are visual and hearing impairments, metabolic abnormalities, sleep disorders,
nutritional deficiencies. ADHD is not associated with specific physical features, although rates
of minor physical anomalies may be relatively elevated.12
Course modifiers:-
Family interaction patterns in early childhood are unlikely to cause ADHD but may influence
its cause or contribute to the secondary development of conduct problems.13
10
DSM-5, page 62
11
DSM-5, page 62
12
DSM-5, page 62
13
DSM-5, page 62

13. FUNCTIONAL CONSEQUENCES OF ATTENTION DEFICIT /
HYPERACTIVITY DISORDER
In children, ADHD is associated with reduced school performance and academic
attainment, social rejection and in adults poorer occupational performance, attainment,
attendance and a higher probability of unemployment as well as interpersonal conflicts.
Children with ADHD are more likely than their peers without ADHD to develop conduct
disorder in adolescence and antisocial personality disorder in adulthood. Individuals with
ADHD are more likely than peers to be injured. Individuals with ADHD are the elevated
likelihood of obesity.
Insufficient or variable self-application to tasks which requires sustained effort is
often interpreted by others as laziness, irresponsibility or failure to co-operate. Family
relationships may be characterized by discord and negative interactions. Peer relationships can
be disrupted by peer rejection, neglect or teasing of the individual with ADHD. Average
individuals with ADHD obtain less schooling, have the poorer vocational achievement and
have reduced intellectual scores than their peers. With elevated symptoms of inattention,
academic deficits, school-related problems, and peer neglect tend to be most associated
whereas peer rejection and, to a lesser extent accidental injury is most significant with the
symptoms of hyperactivity or impulsivity.

14. DIFFERENTIAL DIAGNOSIS
Oppositional defiant disorder:-
 Individuals with the oppositional defiant disorder may resist work or school tasks that
require self- application because they resist conforming to others’ demands.
Complicating the differential diagnosis is the fact that some individuals with ADHD
may develop secondary oppositional attitudes towards such tasks. In the general
population oppositional defiant disorder co-occurs with ADHD in approximately half
of the children with the combined presentation and about a quarter with the
predominantly inattentive presentation
Intermittent explosive disorder:-
 ADHD and intermittent explosive disorder share high levels of impulsive behaviour.
The intermittent explosive disorder can be diagnosed in the presence of ADHD. The
individuals with this disorder do not experience problems with sustaining attention as
seen in ADHD but they show serious aggression towards others.
Other neurodevelopmental disorders:-
 Children with a specific learning disorder may appear inattentive because of frustration,
lack of interest, or limited ability. However, inattention in individuals with a specific
learning disorder who do not have ADHD is not impairing outside of academic work.
Intellectual disability
 A diagnosis of ADHD in intellectual disability requires that inattention or hyperactivity
be excessive for mental age.
Autism spectrum disorder
 Individuals with ADHD and autism spectrum disorder exhibit inattention, social
dysfunction and difficult to manage behaviour.
Reactive attachment disorder
 Children with reactive attachment disorder may show social disinhibition, but not the
full ADHD symptom cluster
Anxiety disorders
 ADHD shares symptoms of inattention with anxiety disorders.

15. Depressive disorders
 Individuals with depressive disorders may present with an inability to concentrate.
Bipolar disorder
 In bipolar disorder, increased impulsivity or inattention is accompanied by elevated
mood, grandiosity and other specific bipolar features. Children with ADHD may show
significant changes in mood within the same day.
Personality disorders
Disruptive mood dysregulation disorder
 Disruptive mood dysregulation disorder is characterized by pervasive irritability and
intolerance of frustration, but impulsiveness and disorganized attention are not essential
features. Most children and adolescents with disruptive mood dysregulation disorder
have symptoms that meet criteria for ADHD
Substance use disorders
Psychotic disorders:-
 ADHD is not diagnosed if the symptoms of inattention and hyperactivity occur
exclusively during the course of a psychotic disorder.
Medication-induced symptoms of ADHD
Neurocognitive disorders

16. CAUSES OF ATTENTION – DEFICIT / HYPERACTIVITY DISORDER
Medical Hyperthyroidism
Sleep apnea syndrome
Pinworms
Intercurrent illness
Neurology Prematurity
Perinatal asphyxia
Congenital infection
Head trauma
Difficult delivery
Sydenham chorea
Toxic Phenobarbital
Antihistamines
Lead
Food substances
Phenothiazines
Psychological Anxiety
Depression
Manic syndrome
Social
environmental Overstimulation
Boredom
Failure or limit setting
Genetic
Constitutional Familial pattern
Temperament
Adapted from Pediatrics neurology and psychiatry common ground by Herskowitz Joel,
Rosman Paul, page 410

17. CONCLUSION
Hyperactivity is one symptom of a syndrome comprising hyperkinesis, impulsivity,
inattention and overexcitability. These can generally be subsumed under the diagnosis of
attention deficit disorder, which may occur with hyperactivity. ADHD typically occurs in
school age and is often on a developmental, frequently familial basis.
ADHD must be distinguished from normal activity for age. Hyperactivity can be
seen with hyperthyroidism, Sydenham chorea. Learning disabilities frequently accompany
attention deficit disorder adding stress that often worsens behavioural problems. Treatment is
almost always multifaceted, involving child, parent, teacher and other parties.
Pharmacotherapy may be beneficial but it should not be considered as the sole mode of therapy.
The outlook for the child with ADHD is for deduction of increased motor activity
in adolescences and young adulthood. Impulsivity, distractibility and social academic
disabilities often persist with ADHD. The lifelong effects of the attention deficit hyperactivity
disorder are still unknown.
When treating an ADHD child, it is important to make them happy by creating a
brain healthy environment. In here, play therapy is significant and it enables children, to rise
from inappropriate behaviours associated with ADHD and help them cope with this disorder
better. Consequently, children can do become more mature, more positive in his/her attitudes,
and more constructive in the way he/she expresses his/her inner feelings. It was also found that
emotional problem is a barrier and influences the performance of ADHD children and their
mental health. In addition, concentration and self-control treatment can help them to cope with
their disorder.
But anyhow when conserving a child with ADHD, is pretty difficult because
sometimes are not even diagnosed as ADHD. So that proper attention towards the child is a
must. Therefore, it becomes imperative for the teacher and parents to take utmost care in the
well being of ADHD children

18. TREATMENTS
Drug therapy is often an essential part of the management of attention deficit hyperactivity
disorder. But it must not be the sole focus of therapeutic attention.
Treatments Of Attention Deficit Hyperactivity Disorder
Medical
 Symptomatic pharmacotherapy
 Treatment of underlying or continuing medical
illness
Surgical  Adenoidectomy
 Mechanical ventilation for sleep apnea
Psychological  Treatments for depression, anxiety
 Explanation to the child
 Parental counselling
 Behaviour modification
Social
environmental
 Quiet environment
 Stimulus poor area for doing homework
 Scheduled activities
 Time off for parents
Educational  Remediation for associated learning problems
 Preferential seating arrangements
 Four walled classrooms
 Small teacher to student ratio
Physical  Adaptive physical education
 Encouraging of athletic abilities
Adapted from Pediatrics neurology and psychiatry common ground by Herskowitz Joel,
Rosman Paul, page 419

19. CONTENT
Page no
1. Introduction................................................................................. 3
2. Classification of child mental disorders ...................................4
3. Attention – deficit / hyperactivity disorder..............................7
4. Diagnostic criteria of
attention - deficit / hyperactivity disorder................................8 – 9
5. Diagnostic features......................................................................10 – 12
6. Development and course of
attention – deficit / hyperactivity disorder...............................13
7. Risk and prognostic factors of attention – deficit / hyperactivity
disorder........................................................................................14
8. Functional consequences of
Attention - deficit / hyperactivity disorder...............................15
9. Differential diagnosis..................................................................16 – 17
10.Causes of attention – deficit / hyperactivity disorder .............18
11.Treatments...................................................................................19
12.Conclusion ...................................................................................20
13.Bibliography................................................................................21

20. BIBLIOGRAPHY
1) Diagnostic and statistical manual of mental disorders fifth edition
2) Herskowitz Joel, Rosman Paul N 1982 Pediatrics neurology and
psychiatry common ground Macmillan publishing, New York