Attention Deficit Disorder (ADD)

Primary Laos2[1]

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.

Attention Deficit Disorder originates from the following process: congenital.

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].

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.

Self-assessment

References

  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.

  • A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities - M Linden, T Habib, V Radojevic - Applied Psychophysiology and , 1996 - Springer
  • A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder. - T Spencer, T Wilens, J Biederman - Archives of General , 1995 - psycnet.apa.org
  • A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes - T Sagvolden, EB Johansen, H Aase - Behavioral and Brain , 2005 - Cambridge Univ Press
  • A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults - PH Wender, FW Reimherr, D Wood - Am J , 1985 - Am Neuropsych Assoc
  • A twin study of the etiology of comorbidity: attention-deficit hyperactivity disorder and dyslexia - JW Gilger, BF Pennington, J DeFRIES - of the American Academy of Child , 1992 - Elsevier
  • A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders - DTR Rossiter, TJ La Vaque - Journal of Neurotherapy, 1995 - Taylor & Francis
  • A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder - CD Coles, KA Platzman - Alcoholism: Clinical , 1997 - Wiley Online Library
  • Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study - F Levy, DA Hay, M McSTEPHEN, C Wood - Journal of the American , 1997 - Elsevier
  • ADHD With Comorbid Disorders: Clinical Assessment and Management. - SR Pliszka, CL Carlson, JM Swanson - 1999 - ERIC
  • Association of attention-deficit disorder and the dopamine transporter gene. - EH Cook Jr, MA Stein, MD Krasowski - American journal of , 1995 - ncbi.nlm.nih.gov
  • Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments - K Murphy, RA Barkley - Comprehensive psychiatry, 1996 - Elsevier
  • Attention deficit disorder: a review of the past 10 years - DP Cantwell - Journal of the American Academy of Child & , 1996 - Elsevier

Media References

  1. Primary Laos2, Public Domain

Languages

Self-assessment