Attention deficit disorder and attention deficit hyperactivity disorder are types of psychiatric illnesses, characterized by development of problems, such as attention, impulsive behavior and hyperactivity. Such a type of conditions is a common occurrence, amongst the school going children.
Presentation
In some cases, symptoms are spotted when the child is 2 -3 year old. Children present usually with the following signs and symptoms:
- Difficulty in attention
- Gets distracted easily
- Not listening and difficulty in following instructions
- Forgetfulness
- Impatient and experiences difficulty in waiting for turn
- Extremely talkative
- Has habit of interrupting other’s conversations
- Difficulty in organizing tasks and other activities
- Keeps fiddling with something
- Restless
- Difficulty in completing tasks assigned at school
- Frequently keeps losing essential items, such as books or pencils or other belongings
ADHD is a common phenomenon amongst boys, than girls, and both the sexes’ exhibit different behavior pattern. For example, boys tend to be more hyperactive, and girls are more inattentive but quiet [6].
Entire Body System
- Epilepsy
Adaptive phase I study of OROS methylphenidate in attention deficit hyperactivity disorder with epilepsy. Epilepsy Behav 2010 ; 18(3): 229 – 237. Google Scholar | Crossref | Medline | ISI 18. Deonna, T, Zesiger, P, Davidoff, V. [doi.org]
So far, atomoxetine has not been demonstrated to have any adverse effect in children with epilepsy. [ncbi.nlm.nih.gov]
Epilepsy The Epilepsy Foundation of America defines epilepsy as a physical condition that occurs when there is a sudden, brief change in how the brain works. [doe.virginia.gov]
The meta‐analysis showed that (1) the relative risk of epilepsy in individuals with coeliac disease, and of coeliac disease in individuals with epilepsy, compared with the general population, was 2.1 and 1.7, respectively, and the risk difference was [dx.doi.org]
- Pain
The efficacy of acupuncture for five diseases (Cerebral Palsy (CP), nocturnal enuresis, tic disorders, amblyopia, and pain reduction) is promising. [ncbi.nlm.nih.gov]
This estimate was the same regardless of indication (ie, fever and infections or pain conditions). [doi.org]
National Institutes of Health studies have shown it to be effective for treating pain, and many insurance plans cover such treatments. "More recently we've been using it for attention deficit disorder, allergies and asthma," said Dr. [tampabay.com]
These included difficulty falling asleep, 17.9% (95% CI 14.7% to 21.6%; 82 studies, 11,507 participants); headache, 14.4% (95% CI 11.3% to 18.3%; 90 studies, 13,469 participants); abdominal pain, 10.7% (95% CI 8.60% to 13.3%; 79 studies, 11,750 participants [cochrane.org]
Founded in 1987, Cephalon, Inc. is an international biopharmaceutical company dedicated to the discovery, development and marketing of innovative products to treat sleep and neurological disorders, cancer and pain. [phx.corporate-ir.net]
- Rigor
Rigor of ADHD diagnoses was also split into three categories, low, medium and high. Low rigor referred to subjects put into the ADHD category based solely on a teacher or parent interview of the child. [doi.org]
One rigorous systematic review found that many studies lack a sufficiently long‐term follow up and tend to score low on measures of quality ( Jadad 1999 ). [dx.doi.org]
The committee of experts that has developed the DSM-IV criteria catalog clearly uses rigorous and empirically derived criteria, has looked at all rating scales for diagnosing ADHD and has reviewed the ADHD literature. [ncbi.nlm.nih.gov]
This is partly because of an increased awareness and recognition of the disorder, but to some extent it is also because of misdiagnosis and the diagnostic criteria for ADHD not always being applied as rigorously as they should be. [brainfoundation.org.au]
- Cerebral Palsy
The efficacy of acupuncture for five diseases (Cerebral Palsy (CP), nocturnal enuresis, tic disorders, amblyopia, and pain reduction) is promising. [ncbi.nlm.nih.gov]
Conditions like intellectual disability and cerebral palsy also affect the way the different parts of the brain talk to each other. [raisingchildren.net.au]
ADD is found more often in children who have other brain defects, such as those leading to mental retardation, cerebral palsy, or temporal lobe epilepsy. [itmonline.org]
- Chills
I cope better with setbacks, I have more chill. But none of that really gets at the thing which to me seems magical, but doubtless just approximates everyday experience for most. The only way I can put it is that there seems to be more time. [theguardian.com]
"It was a chilling bill because it signaled to the teacher that don't you dare suggest that there may be a problem," says Jim McDonough, who runs the Florida Office of Drug Control, which is also responsible for suicide prevention in the state. [salon.com]
(e.g. hit other children) and what I should have done instead” Establish a quiet “chill out” location where child can be sent for regaining emotional control when child is upset Use formal time outs in class or private room; hallway time outs don’t work [continuingedcourses.net]
Gastrointestinal
- Abdominal Pain
These included difficulty falling asleep, 17.9% (95% CI 14.7% to 21.6%; 82 studies, 11,507 participants); headache, 14.4% (95% CI 11.3% to 18.3%; 90 studies, 13,469 participants); abdominal pain, 10.7% (95% CI 8.60% to 13.3%; 79 studies, 11,750 participants [cochrane.org]
The most common side effects with Intuniv are sleepiness (in nearly half of all patients), headache (in more than a quarter), tiredness (in about 1 patient in 5), and upper abdominal pain and sedation (both in around 1 in 10). [ema.europa.eu]
pain of uncertain origin History of head injury Dark thoughts (may involve suicidal or homicidal thoughts) Possible learning disabilities May or may not be hyperactive Temporal Lobe ADD SPECT scan findings show decreased activity (and occasionally increased [amenclinics.com]
Gastrointestinal manifestations include chronic or recurrent diarrhea, malabsorption, abdominal pain and distention, bloating, vomiting, and weight loss. [ncbi.nlm.nih.gov]
Ears
- Hearing Impairment
Most districts have the availability of a hearing impairment specialist to consult on these clients. [web.archive.org]
Hearing impairment and congenital disorders are particularly common examples of a range of medical conditions that need to be detected if present. 2.2.3. [ncbi.nlm.nih.gov]
Skin
- Urticaria
Varieties of wheat allergy include: classic food allergy; wheat-dependent, exercise-induced anaphylaxis (WDEIA); occupational asthma (baker's asthma) and rhinitis; and contact urticaria. [ncbi.nlm.nih.gov]
Psychiatrical
- Impulsivity
Types of ADHD There are 3 types of ADHD: Inattentive means a person is easily distractible or inattentive but isn’t hyperactive or impulsive. Hyperactive-Impulsive occurs when a person has symptoms of impulsivity and hyperactivity. [healthdirect.gov.au]
This means a person shows enough symptoms of inattention (or easy distractibility) but isn’t hyperactive or impulsive. 2. Hyperactive/impulsive This type occurs when a person has symptoms of hyperactivity and impulsivity but not inattention. 3. [healthline.com]
[…] hyperactivity A behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. [icd9data.com]
- Fidgeting
ADD is a type of ADHD that doesn't involve constant movement and fidgeting. But it's a blurry distinction. The confusion dates to 1994. [webmd.com]
Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity. [nimh.nih.gov]
- Anxiety Disorder
About 50 percent of adults with ADHD also suffer from an anxiety disorder. Adult ADHD symptoms that coexist with an anxiety disorder or other disorders may significantly impair the ability to function. [adaa.org]
[…] self break down generalized anxiety disorder an anxiety disorder characterized by chronic free-floating anxiety and such symptoms as tension or sweating or trembling or lightheadedness or irritability etc that has lasted for more than six months congenital [vocabulary.com]
A structured psychiatric interview with his parents revealed no other causes of these symptoms by excluding the possibility of anxiety disorder or mood disorder, among others. (See Table 2 for differential diagnosis.) [jamanetwork.com]
People with ADHD may also have additional problems, such as sleep and anxiety disorders. Getting help Many children go through phases where they're restless or inattentive. [nhs.uk]
[…] type F91.2 Conduct disorder, adolescent-onset type F91.3 Oppositional defiant disorder F91.8 Other conduct disorders F91.9 Conduct disorder, unspecified F93 Emotional disorders with onset specific to childhood F93.0 Separation anxiety disorder of childhood [icd10data.com]
- Anger
Anger management tactics can help those with ADHD and anger issues learn to manage emotions and handle anger properly. Support groups can offer a helping hand as well. [web.archive.org]
ADHD is widely known by its colloquial definition: ‘anger.’ [ncbi.nlm.nih.gov]
[…] easily. provide brief training in anger control: encourage student to walk away; use calming strategies; tell nearby adult if getting angry if reading is weak: provide additional reading time; use "previewing" strategies; select text with less on a page [addwarehouse.com]
"Keep positive, take control of your anger and take responsibility for your actions then you will be able to cope." Scott. [cyh.com]
- Dyslexia
The present study assessed increasingly complex gross motor skills in children and adolescents with dyslexia, AD, and with both Dyslexia and AD. [ncbi.nlm.nih.gov]
Academic Skills Disorders Developmental Reading Disorder – This is more commonly known as Dyslexia. [web.archive.org]
Neurologic
- Hyperactivity
Types of ADHD There are 3 types of ADHD: Inattentive means a person is easily distractible or inattentive but isn’t hyperactive or impulsive. Hyperactive-Impulsive occurs when a person has symptoms of impulsivity and hyperactivity. [healthdirect.gov.au]
Attention deficit disorder and attention deficit hyperactivity disorder are types of psychiatric illnesses, characterized by development of problems, such as attention, impulsive behavior and hyperactivity. [symptoma.com]
This means a person shows enough symptoms of inattention (or easy distractibility) but isn’t hyperactive or impulsive. 2. Hyperactive/impulsive This type occurs when a person has symptoms of hyperactivity and impulsivity but not inattention. 3. [healthline.com]
ADHD Overview ADHD stands for attention deficit hyperactivity disorder, a condition with symptoms such as inattentiveness, impulsivity, and hyperactivity. The symptoms differ from person to person. [webmd.com]
- Forgetful
Symptoms: Symptoms of ADHD include poor attention, hyperactivity, excessive talkativeness and forgetfulness. Affected children, have difficulty in completing their tasks, organizing their work and taking care of their belongings. [symptoma.com]
People with this form of ADHD often lose focus, are forgetful, and seem to have trouble listening. [additudemag.com]
[…] important events or dates, not fulfilling daily responsibilities due to forgetfulness. [elevationbehavioralhealth.com]
People with ADHD of the inattentive type have trouble paying attention to details, are easily distracted, often have trouble organizing or finishing tasks and often forget routine chores (such as paying bills on time or returning phone calls). [my.clevelandclinic.org]
Have trouble staying on topic while talking, not listening to others, and not following social rules Be forgetful about daily activities (for example, missing appointments, forgetting to bring lunch) Be easily distracted by things like trivial noises [webmd.com]
- Behavior Problem
Ultimately, Bradley was unable to identify the organic cause of behavioral problems and failed to define the type of problem child who would best respond to the drug [ 8 ]. [ncbi.nlm.nih.gov]
Behavior intervention plans can help students with problem behaviors, whether they actually have ADD or exhibit ADD-like behaviors. [verywellmind.com]
As our expert says, ADD/ADHD is not a behavior problem. It has far more to do with the brain’s management system. Remember, ADHD has nothing to do with how smart a person is. [youtube.com]
Children with ADHD have difficulty with attention, hyperactivity, impulsivity and behavioral problems. [web.archive.org]
- Irritability
Common Symptoms in Limbic ADD Core symptoms of ADD Moodiness Negativity Low energy Frequent irritability Tendency for social isolation Feelings of hopelessness Perceived helplessness Feelings of guilt Loss of interest in things Sleep changes (too much [amenclinics.com]
An instrument to measure EI and DESR which demarcates them from irritability and other emotional symptoms could improve the accuracy of diagnostic criteria for ADHD. [doi.org]
[…] usually integrated functions of consciousness and perception of self break down generalized anxiety disorder an anxiety disorder characterized by chronic free-floating anxiety and such symptoms as tension or sweating or trembling or lightheadedness or irritability [vocabulary.com]
However, we require a better understanding of the clinical presentation of NCGS, as well as its pathogenesis, epidemiology, management, and role in conditions such as irritable bowel syndrome, chronic fatigue, and autoimmunity. [ncbi.nlm.nih.gov]
[…] organisational skills inability to focus or prioritise continually losing or misplacing things forgetfulness restlessness and edginess difficulty keeping quiet, and speaking out of turn blurting out responses and often interrupting others mood swings, irritability [nhs.uk]
- Insomnia
Owens, JA, Babcook, D, Blumer, J The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summary. J Clin Sleep Med 2005 ;1: 49 – 59. Google Scholar | Medline | ISI 2.. [doi.org]
Sleep difficulties (delayed sleep phase insomnia) were corrected while performing blind assessments of behavioral symptoms. [ncbi.nlm.nih.gov]
The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summary. J Clin Sleep Med 2005, 1: 49–59. PubMed Google Scholar 45. [oadoi.org]
Workup
For a child to be diagnosed with ADD or ADHD, he/she should meet the diagnostic criteria, given in Diagnostic and Statistical Manual of Mental Disorders [7]. There is no single test to confirm the conditions. The following tests are employed for arriving at a definitive conclusion:
- Medical examination to rule out other underlying disease conditions that may be causing the symptoms
- Gathering information from family and other guardians, who know the child well, about his behavior and habits
- Collecting information from school records, and assessing medical history of family, to understand the cause of the condition
- Use of ADHD rating scales that would help evaluate and collect information about the child
Treatment
A combination of treatment regimes are required, to effectively manage the condition. The following methods are employed, to successfully keep the symptoms under control:
Medications: Psycho stimulants or stimulant drugs are one of the most common medications, given to individuals affected by ADHD. This class of drugs helps boost the levels of neurotransmitters, which in turn brings about an improvement in the signs and symptoms. In addition, children may also be given antidepressants, to help relieve the symptoms. Although, antidepressants have demonstrated a slowed effect than the stimulant drugs; but they are effective in controlling symptoms of ADHD [8].
Behavior therapy and counseling: Along with medications, children also gravely benefit from behavior and counseling therapy. Such types of therapies, help children cope with the symptoms, and teach them skills to overcome depression, and other associated problems [9].
Prognosis
Children, who develop ADHD at a young age, will have a poor prognosis, and may continue to suffer from symptoms till adolescence, in spite of treatment. In about 30 – 50% of cases, ADHD continues to persist even in adulthood years. It has been reported that, less than 5% children suffering from ADHD, manage to get a college degree. Children, as they grow up, gradually learn coping mechanisms, which help them deal with their symptoms.
Etiology
The exact etiology behind development of ADD and ADHD is not completely understood. Interplay of several factors is known to play foul. Following are some of the factors that have an association in development of ADHD [2]:
Heredity: Individuals with a family history of ADHD are at an increased risk of developing the same. It has been found that, several genes have direct affect on dopamine neurotransmission [3].
Environment: Factors such as alcohol consumption during pregnancy, low birth weight, and premature birth, may increase the chances of contracting infections during early childhood days. These may have some association with development of ADHD, later in life.
Epidemiology
It has been estimated that, ADHD affects about 6 – 7 % of individuals aged 18 years and below. Statistics have also reported that, the incidence of ADHD is higher amongst the population of North America, than Middle East and Africa. Boys are 3 – 5 times more likely to develop ADHD, than girls [4].
The age of onset of ADHD is around 7 years. Majority of the children continue to live with the disorder till adulthood. In some cases, symptoms may get corrected, once they reach adolescence. The prevalence of ADHD, amongst the adult population is estimated to be about 2 – 7%.
Pathophysiology
The complete pathology of ADD and ADHD is not clear. It is known that, certain areas of the brain, which are responsible for attention, lack in neural transmission, can favor the development of psychiatric disorder. Neurotransmitters, such as dopamine and epinephrine, have a pivotal role to play in development of ADHD [5].
Malfunctioning of the frontostriatal part of the brain is known to be the major cause of ADHD. Other parts of the brain that may be involved are the cerebellum and parietal lobe. Using diagnostic procedures such as proton magnetic spectroscopy, it was revealed that, adolescents with ADHD, demonstrated neurochemical changes in the right prefrontal region of the brain
Prevention
The following measures can be adopted, to reduce the risk of development of ADD and ADHD in children [10]:
- Pregnant women should avoid use of alcohol and other drugs that would harm the fetus.
- It is necessary to protect the child from harmful environmental toxins. Cigarette smoke, lead paints and agricultural chemicals can in some way, favor development of the disorders.
- It is advised to limit exposure to television, during the first 5 years of life
Summary
Boys are more prone to develop this type of psychiatric disorder than girls. Millions of children are affected by attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), and the conditions continue to haunt until adulthood. No treatment regime can cure the disorders; however various strategies can help in successful management of the condition [1].
Patient Information
Definition: ADHD and ADD are types of psychiatric disorders, wherein the affected children exhibit traits of hyperactivity and poor attention. The condition is more common in boys than girls. Age of onset of ADHD is around 7 years; and many children may continue to live with the condition till adulthood.
Cause: The exact factors that trigger the development of ADHD are unknown. However, interplay of environmental factors and genes have been known to play foul. Individuals, with a family history of ADHD, are at an increased risk of developing the condition.
Symptoms: Symptoms of ADHD include poor attention, hyperactivity, excessive talkativeness and forgetfulness. Affected children, have difficulty in completing their tasks, organizing their work and taking care of their belongings.
Diagnosis: Diagnosis is made by medical examination, to rule out other disease conditions. Gathering information from family, and guardians of the affected child, forms an essential part of the diagnostic process.
Treatment: Medications and therapies form the basis of the treatment regime. Stimulant drugs, anti depressants, and behavior and counseling therapy, are imparted to children affected by ADHD.
References
- National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults.
- Smith AK, Mick E, Faraone SV. Advances in genetic studies of attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2009; 11:143.
- Volkow ND, Wang GJ, Newcorn J, Telang F, Solanto MV, Fowler JS, et al. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. Aug 2007;64(8):932-40.
- Akinbami LJ, Liu X, Pastor PN, Reuben CA. Attention deficit hyperactivity disorder among children aged 5-17 years in the United States, 1998-2009. NCHS Data Brief. Aug 2011;1-8.
- Cherkasova MV, Hechtman L. Neuroimaging in attention-deficit hyperactivity disorder: beyond the frontostriatal circuitry. Can J Psychiatry. Oct 2009;54(10):651-64.
- Levy F, Hay DA, Bennett KS, McStephen M. Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry 2005; 44:368.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association; 2000. 78-85.
- Volkow ND, Swanson JM. Does childhood treatment of ADHD with stimulant medication affect substance abuse in adulthood?. Am J Psychiatry. May 2008;165(5):553-5.
- Levin FR, Kleber HD. Attention-deficit hyperactivity disorder and substance abuse: relationships and implications for treatment. Harv Rev Psychiatry 1995; 2:246.
- Campbell SB, Ewing LJ, Breaux AM, Szumowski EK. Parent-referred problem three-year-olds: follow-up at school entry. J Child Psychol Psychiatry 1986; 27:473.