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Attention Deficit Disorder

ADD

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].

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.[m.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]
  • Third, the concept of “a continuum of cerebral damage ranging from severe abnormalities, such as cerebral palsy and mental deficiency, to minimal damage” was introduced by Knobloch and Pasamanick ( 1959, p. 1384).[doi.org]
Impulsivity
  • […] hyperactivity A behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity.[icd9data.com]
  • Additionally, there are up to four new criteria for impulsivity (there have been only three dimensions compared to inattention or hyperactivity).[ncbi.nlm.nih.gov]
  • However, the small number of impulsivity items in the DSM-IV symptom list may have constrained the ability to distinguish between impulsivity and hyperactivity, and additional research is needed to test whether impulsivity and hyperactivity symptoms may[ncbi.nlm.nih.gov]
  • The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into 2 types of behavioural problems: inattentiveness, and hyperactivity and impulsiveness.[nhs.uk]
  • An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences. Signs and Symptoms Inattention and hyperactivity/impulsivity are the key behaviors of ADHD.[web.archive.org]
Dyslexia
  • Abstract Purpose to analyze and classify the spelling performance according to the semiology of spelling error of children with developmental dyslexia (DD) and with developmental dyslexia associated to attention deficit disorder and hyperactivity(DD and[ncbi.nlm.nih.gov]
  • 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]
  • Abstract The project Adult Dyslexia and Attention Deficit Disorder in Finland (Project DyAdd) compares adults (n 119, 18-55 years) with dyslexia, attention-deficit/hyperactivity disorder (ADHD), dyslexia together with ADHD (comorbid), and healthy controls[ncbi.nlm.nih.gov]
  • […] these qualitative results suggest that the "cerebellar-vestibular (CV) stabilizing" antimotion-sickness medications, Piracetam included, and their combinations may be shown to be therapeutically useful in treating children with learning disabilities or dyslexia[ncbi.nlm.nih.gov]
  • Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood.[nhs.uk]
Emotional Lability
  • Restless/Impulsive [SMD 0.39 (CI ‐0.21, 1.00)] and Emotional Lability [SMD 0.41 (CI ‐0.19, 1.02)].[doi.org]
  • The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD . European Psychiatry, Vol. 55, Issue. , p. 45. CrossRef Google Scholar Jaite, Charlotte van Noort, Betteke Maria Vloet, Timo D.[doi.org]
  • The detected hypoconnectivity within regions of the limbic CSTC loop correlated with increased emotional lability.[ncbi.nlm.nih.gov]
  • Numerous trials have found that ATX improves quality of life and emotional lability in addition to core ADHD symptoms.[ncbi.nlm.nih.gov]
  • Sobanski E, Banaschewski T, Asherson P, et al.: Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence.[doi.org]
Emotional Outbursts
Hyperactivity
  • Attention deficit hyperactivity disorder combined Attention deficit hyperactivity disorder combined type Attention deficit hyperactivity disorder, combined type Attention deficit hyperactivity disorder, hyperactive impulsive type Attention deficit hyperactivity[icd9data.com]
  • Each subject with a combined score in the first 2 subscales (inattention, hyperactivity/impulsivity) at or above the 90th percentile was classified as having symptoms of attention deficit disorder with hyperactivity.[ncbi.nlm.nih.gov]
  • Attention Deficit Hyperactivity Disorder in Prison Inmates [PhD thesis] [ Google Scholar ] 61. Hazell P. Review of attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder.[ncbi.nlm.nih.gov]
  • Morrison JR (1980a) Adult psychiatric disorders in parents of hyperactive children. Am J Psychiatry 137:825–827 Google Scholar 84. Morrison JR (1980b) Childhood hyperactivity in an adult psychiatric population: social factors.[doi.org]
  • Moderators and mediators of treatment response for children with attention-deficit/ hyperactivity disorder: the multimodal treatment study of children with attention-deficit/hyperactivity disorder.[oadoi.org]
Behavior Problem
  • Child behavior problems increased by maternal smoking during pregnancy. Arch Environ Health. 1999; 54 (1):15–19. [ PubMed ] [ Google Scholar ] Parsons PJ, Slavin W.[ncbi.nlm.nih.gov]
  • Furthermore, since the effect was not limited to any one type of behavior problem, a wide range of children could potentially benefit from the medication.[ncbi.nlm.nih.gov]
  • Children with ADHD have difficulty with attention, hyperactivity, impulsivity and behavioral problems.[web.archive.org]
  • Studies of sleep disturbances in children with academic and behavioral problems have also underscored the role that primary sleep disorders such as obstructive sleep apnea hypopnea syndrome play in the clinical presentation of symptoms of inattention[oadoi.org]
Meningism
  • Childhood illnesses associated with attention-deficit/hyperactivity disorder include virus infections, meningitis, encephalitis, head injury, epilepsy, toxins, and drugs.[ncbi.nlm.nih.gov]
  • Neurological sequelae of septic meningitis: a follow-up study of 65 children. Isr J Med Sci 1979; 15(6): 512–7 PubMed Google Scholar 81. Dell’Anna ME, Luthman J, Lindqvist E, et al. Development of monoamine systems after neonatal anoxia in rats.[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%.

Sex distribution
Age distribution

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

Article

  1. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults. 
  2. Smith AK, Mick E, Faraone SV. Advances in genetic studies of attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2009; 11:143.
  3. 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. 
  4. 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.
  5. Cherkasova MV, Hechtman L. Neuroimaging in attention-deficit hyperactivity disorder: beyond the frontostriatal circuitry. Can J Psychiatry. Oct 2009;54(10):651-64.
  6. Levy F, Hay DA, Bennett KS, McStephen M. Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry 2005; 44:368.
  7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association; 2000. 78-85.
  8. 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.
  9. Levin FR, Kleber HD. Attention-deficit hyperactivity disorder and substance abuse: relationships and implications for treatment. Harv Rev Psychiatry 1995; 2:246.
  10. 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.

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Last updated: 2019-07-11 20:25