Dikkat Eksikliği Hiperaktivite Bozukluğu
Dikkat Eksikliği Hiperaktivite Bozukluğu’nun (DEHB)’in oluşumu genel olarak psikolojik ve nörobiyolojik faktörler (beyindeki aktivitelerin düzenlenmesinde ve uyaranların taşınmasında yetersizlik), duygularını düzenleyememe, bellek problemleri ve kendini motive etmede eksiklik gibi pek çok faktörle açıklanmaktadır. DEHB’in temel özelliği, kalıcı ve sürekli olan dikkat süresinin kısalığı, engellemeye yönelik denetim eksikliği nedeniyle davranışlarda ya da bilişte ortaya çıkan ataklık ve huzursuzluktur. Bunun sonucu olarak çocukta bulunduğu gelişim dönemine uymayan dikkatsizlik ya da aşırı hareketlilik vardır. Başlangıcı genellikle üç yaş dolaylarında olmakla birlikte, tanı düzenli öğrenim için gerekli dikkat süresi ve yoğunlaşmanın gelişmesinin beklendiği ilkokul yıllarında konmaktadır.
DEHB’da klinik belirtiler dikkat, konsantrasyon, hareketlilik ve dürtü kontrolü alanlarındaki sorunlarla karakterizedir.
Aşırı Hareketlilik: Hareketlilik çocukluk döneminin normal özelliklerindendir. Hareketliliğin yaşıtlarına göre belirgin olarak fazla olduğu, bu davranışların oyun, anaokulu, okul gibi günlük işlevlerde, arkadaş, aile ve/veya öğretmenler için sorun oluşturduğu yani çocuğun işlevselliğini etkilediği durumlarda aşırı hareketlilikten söz edilebilir.
Dikkatsizlik: DEHB’li çocuklar dikkatlerini bir noktaya toplamakta zorluk yaşamaktadırlar. Ayrıca, dışardan gelen uyaranlarla dikkatin kolayca dağılması, düzenini sürdürmede zorlanma, eşya ve oyuncakları sık sık kaybetme, aldığı sorumluluk ve görevleri unutma gibi belirtiler de dikkat problemlerine işaret ederler.
Dürtüsellik: Sırasını beklemede zorlanma, isteklerini erteleyememe, daha soru bitmeden yanıt verme, acelecilik, başkalarının sözlerini kesme gibi davranışlar ve bu davranışlar sonucu çocuğun işlevselliğinin olumsuz yönde etkilenmesi durumu, dürtüsellik sorunlarını düşündürmelidir.
Hiperaktivite belirtileri:
- Elleri, ayakları kıpır kıpırdır ya da oturduğu yerde kıpırdanıp durur.
- Sınıfta ya da oturması beklenen diğer durumlarda yerinden kalkar.
- Uygunsuz olan durumlarda koşuşturup durur ya da tırmanır (ergenlerde ya da erişkinlerde öznel huzursuzluk duygularıyla sınırlı olabilir.)
- Sakin bir biçimde, boş zamanları geçirme etkinliklerine katılma ya da oyun oynama zorluğu vardır.
- Hareket halindedir ya da bir motor tarafından sürülüyor muş gibi davranır.
- Çok konuşur.
- Sorulan soruları soru tamamlanmadan önce cevabını verir.
- Sıra bekleme güçlüğü vardır.
- Başkalarının sözünü keser ya da yaptıklarının arasına girer. (Örneğin başkalarının konuşmalarına ya da oyunlarına karışır.)
Dikkat eksikliği bozukluğu belirtileri:
- Dikkatini ayrıntılara veremez, hatalar yapar.
- Üzerine aldığı görevlerde ya da oynadığı etkinliklerde dikkati dağılır.
- Doğrudan kendisiyle konuşulduğunda çoğu zaman dinlemiyormuş gibi görünür.
- Yönergeleri izlemez ve görevlerini tamamlayamaz.
- Üzerine aldığı görevleri ve etkinlikleri düzenlemekte zorluk çeker.
- Sürekli mental çabayı gerektiren görevlerden kaçınır, bunları sevmez ya da bunlarda yer almaya karşı isteksizdir.
- Üzerine aldığı görevler ya da etkinlikler için gerekli olan şeyleri kaybeder .
- Dikkati dış uyaranlarla kolaylıkla dağılır.
- Günlük etkinliklerde çoğu zaman unutkandır.
Bu maddeler değerlendirilirken elbette çocuğun yaşına göre yorumlanacaktır. Bir kişide dikkat eksikliği ve hiperaktivite var diyebilmek için, bu belirtilerin yedi yaşından önce başlamış olması ve en az altı ay süreyle devam ediyor olması gereklidir. Dikkat eksikliği ve hiperaktivite bozukluğu tedavi edilmezse çocuğun özgüveninde azalma olması ve kapasitesinin altında başarı göstermesi beklenen sonuçlardır. Kaza ve yaralanma riski yüksek olduğu gibi ilişkilerinde sorun görülmesi ve zamanla psikiyatrik bozuklukların tabloya eklenmesi de olasıdır.
Tedaviye başlamak için ille de çocuğun ders başarısının düşmesi gerekmez. DEHB olan çocukların tamamında ders başarısı kötü olur diye bir kural yoktur. Özellikle iyi kapasiteye sahip DEHB olan çocukların ders başarıları uzun yıllar iyi gidebilir. DEHB’de çocukları merkeze alan yöntemler incelendiğinde, bilişsel müdahaleler, kendi kendine yönerge verme ve kendini yönetme stratejilerinin yer aldığı görülmektedir. DEHB’nin belirtilerinin azaltılmasında ve davranış problemlerinin geriletilmesinde bilişsel davranışçı terapi, ebeveyn eğitimi, ailede ve okulda uygulanacak edimsel koşullanma yöntemleri ve bilişsel yöntemlerin önemi ve etkisi, yapılan deneysel çalışmalarla ortaya konulmuştur.
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