Primary prevention
As the pathophysiology of attention deficit hyperactivity disorder (ADHD) is thought to have a strong genetic component, primary prevention is difficult. However, parents can control potentially causative environmental risk factors such as lead exposure at home. There are conflicting data regarding whether omega-3 fatty acids have a positive effect on ADHD symptoms.[87][88][89] Requiring helmets for sports including bicycle riding can help reduce the risk of traumatic brain injury. On a broader societal level, ever-higher academic expectations may cause children stress at increasingly younger ages when they are less developmentally able to attend and focus. Parents and teachers can teach children how to keep a planner to keep track of their work, work on homework together, and integrate extracurricular activities such as sports, which channel hyperactivity productively. Individual sporting activities such as martial arts may be preferred over team sports by children with coordination difficulties, and may better facilitate the child to track their individual progress. Maintaining positive self-esteem by setting reasonable expectations and nurturing areas of academic and extra-curricular strength is critical.
Secondary prevention
Secondary prevention in ADHD focuses on preventing recurrence or exacerbation of ADHD symptoms as the child develops. The physician should regularly assess functioning in multiple domains (including academic performance, mood, anxiety, acting-out behaviour, self-esteem). Behaviour assessment should take place with clinical interviews with the patient, parent, and potentially teachers. If the child is growing, medication doses may need to be increased to maintain the same level of efficacy. Medication non-compliance is more the rule than the exception, and this will have to be addressed in an ongoing way. Particular attention should be paid to subtle side effects that may make medication unacceptable; these can sometimes be ameliorated by dose adjustment or switching to another delivery system. However, non-adherence can also derive from lack of understanding of the goals of treatment or a philosophical rejection of medication; this requires a strong therapeutic partnership with patient and family, and increased knowledge of the disorder. Psychoeducation is a very important aspect of successful long-term treatment as it is helpful to anticipate the developmental challenges children with ADHD face as they enter adolescence and young adulthood.[32]
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