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Attention Deficit Hyperactivity Disorder

Attention Deficit Disorder with Hyperactivity

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental psychiatric disorder.


Presentation

Children and youngsters with ADHD present with one or more of the following signs and symptoms:

  • Lack of attention to details
  • Average or below average memory, have trouble remembering most things 
  • Easily distracted
  • Careless behavior, frequently lose possessions, mix up things, etc.
  • Not good at following instructions 
  • Unable or not good at completing step by step projects 
  • Unable to stay focused
  • Unable to stay still, continuously fidget and move
  • Constantly 'up to something'
  • Talk excessively and energetically 
  • May act without thinking 
  • Impatience 
  • Mood swings
Short Stature
  • An 18-year-old female presented with short stature, obesity, developmental delay, speech delay, dyslexia, attention deficit hyperactivity disorder, and intellectual disability.[ncbi.nlm.nih.gov]
Cerebral Palsy
  • This study aimed to identify content commonalities and differences among the ICF Core Sets for cerebral palsy (CP), and the newly developed Core Sets for autism spectrum disorder (ASD) and attention-deficit-hyperactivity disorder (ADHD).[ncbi.nlm.nih.gov]
Bruxism
  • The prevalence of bruxism and dental erosion was higher in Groups 1 and 2 than in Group 3, but the differences were not significant (P 0.05). In Group 2, subjective dry mouth feel was reported by 32.5% of patients and 17.5% had a very low SSFR.[ncbi.nlm.nih.gov]
  • Review of systems is significant for nightly mouth breathing and snoring, but no night waking, bruxism, or daytime sleepiness.[ncbi.nlm.nih.gov]
Periodontitis
  • ADHD children that were medicated exhibited similar dental caries prevalence and periodontal health status.[ncbi.nlm.nih.gov]
Short Arm
  • Partial trisomy of chromosome 5 was first described by Lejeune et al. in 1964 on the short arm (12). The vast majority of the partial trisomy 5 cases include 5p duplications; however we reported a small supernumerary marker chromosome.[ncbi.nlm.nih.gov]
Broad Nasal Bridge
Hyperactivity
  • When treating adolescent attention deficit hyperactivity disorder patients, the rare possibility of the development of schizophrenia spectrum disorder from attention deficit hyperactivity disorder like symptoms should be kept in mind.[ncbi.nlm.nih.gov]
  • We examined whether current overall attention deficit hyperactivity disorder (ADHD), inattention, or hyperactivity symptom severities are associated with the current presence and persistent history of sleep problems.[ncbi.nlm.nih.gov]
  • Using a VT analysis two subgroups of children with ADHD, girls, and boys with both higher levels of CD and lower levels of hyperactivity, were identified.[ncbi.nlm.nih.gov]
  • Attention deficit hyperactivity disorder (ADHD) is a potentially lifelong condition involving inattentiveness, hyperactivity, and impulsiveness. Attention deficit hyperactivity disorder is one of the most common childhood psychiatric disorders.[ncbi.nlm.nih.gov]
  • Factor loadings on the postulated factors had salient loadings  .31 except for one item on the hyperactivity factor.[ncbi.nlm.nih.gov]
Forgetful
  • They have brought you their own and his advisor's Vanderbilt's, which each endorse 7 of 9 inattentive symptoms including trouble organizing, poor attention to detail, and easily distracted and forgetful in daily activities.His birth history and developmental[ncbi.nlm.nih.gov]
  • They have brought you their own and his advisor's Vanderbilt's, which each endorse 7 of 9 inattentive symptoms including trouble organizing, poor attention to detail, and easily distracted and forgetful in daily activities.[ncbi.nlm.nih.gov]
  • Forgetfulness Kids with ADHD may be forgetful in daily activities. They may forget to do chores or their homework. They may also lose things often, such as toys. 14.[healthline.com]
  • Children with ADHD often have trouble with the following: Paying attention Sitting still Talking out of turn Being forgetful or losing things Acting without thinking about consequences There is no cure for ADHD, but the symptoms can be managed.[yalehealth.yale.edu]
  • They may seem bored and fail to complete work, or they may show signs of confusion, forgetfulness, daydreaming, and disorganization. At times, children seem to be “overfocused” in areas they are interested in.[my.clevelandclinic.org]
Irritability
  • For the safety outcomes, according to drug ranks, LDX was more likely to cause sleep disorders (39%) as well as loss of appetite (65%) and behavior problems such as irritability (60%). BSP (71%) and EDX (44%) caused less appetite decrease.[ncbi.nlm.nih.gov]
  • Most common are: loss of appetite, weight loss, sleeping disorders, irritability, headache. These side effects are well-known and documented in the literature.[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]
  • […] sit still, especially in calm or quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking acting without thinking interrupting conversations little or no sense of danger mood swings, irritability[thesun.co.uk]
  • […] disabilities, including problems with understanding and communicating Anxiety disorders, which may cause overwhelming worry, nervousness Depression, which frequently occurs in children with ADHD Disruptive mood dysregulation disorder, characterized by irritability[mayoclinic.org]
Excessive Talking
  • talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with[nhs.uk]
  • Talks excessively Has difficulty engaging in quiet activities Loses or forgets things repeatedly and often Inability to stay on task; shifts from one task to another without bringing any to completion The symptoms of ADHD may resemble other medical conditions[stanfordchildrens.org]
  • ADHD may also include problems with hyperactivity (fidgeting, excessive talking, restlessness) and impulsivity (difficulty waiting one’s turn or with patience, interrupting others).[psychcentral.com]
  • Symptoms of bipolar disorder , including high energy level, excessive talking, racing thoughts that make it difficult to concentrate, impulsive decision-making, risk-taking, and intrusive behaviors, can also be confused with symptoms of ADHD.[verywell.com]
Excitement
  • To compensate, they are drawn to new and exciting experiences and get famously impatient and restless with the regimented structure that characterizes our modern world.[nytimes.com]
  • Fifty kids are regularly playing a cognitive training program that has been well disguised as an exciting video game. Pediatrician Dr. Laura Gerber knows ADHD well – she and her children have it.[cbc.ca]
  • […] tention deficit hyperactivity child AD/HD, attention deficit hyperactivity disorder DSM, Diagnostic and Statistical Manual of Mental Disorders ICD, International Classification of Diseases A behavioural syndrome of childhood characterised by overactivity, excitability[jnnp.bmj.com]
  • Provide Opportunities for Success — A child knows when you are truly excited and happy for them. Provide them with opportunities where they can succeed. Engage them in creative activities such as painting and sketching.[draxe.com]
Impulsivity
  • Latent factor associations were especially salient between emotional dysregulation and problems with self-concept, and also partially with impulsivity/emotional lability.[ncbi.nlm.nih.gov]
  • Consistent evidence supports a relationship between childhood behavioral problems, executive functioning, inhibition/impulsivity, ADHD, and ASD with obesity across the lifespan.[ncbi.nlm.nih.gov]
  • The disorder is characterized by inattention, impulsivity, and/or motor hyperactivity, which often affect the development and social integration of affected subjects.[ncbi.nlm.nih.gov]
  • The 90th percentile cut-off was used to establish the prevalence of inattention, hyperactivity/impulsivity and combined subtype.[ncbi.nlm.nih.gov]
  • Hyperactivity and Impulsivity Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent[tourette.org]
Distractibility
  • Attention-deficit/hyperactivity disorder (ADHD) is an executive function disorder that may manifest as lack of vigilance, an inability to adapt to the rapid changes associated with anesthesia cases, distractibility, an inability to prioritize activities[ncbi.nlm.nih.gov]
  • The most common type of ADHD, this is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility. Inattentive and distractible type.[bswhealth.com]
  • The “core,” or main, symptoms of ADHD include: Inattentiveness (trouble paying attention) Distractibility (easily distracted) Impulsivity (doing things on sudden urges) Hyperactivity (restlessness) Some children may have ADHD without hyperactivity.[my.clevelandclinic.org]
  • She had struggled with distractibility and disorganization since the fourth grade. At home, Sarah's mother described her as "spacey" and unable to complete the morning routine without constant supervision.[ncbi.nlm.nih.gov]
  • They have brought you their own and his advisor's Vanderbilt's, which each endorse 7 of 9 inattentive symptoms including trouble organizing, poor attention to detail, and easily distracted and forgetful in daily activities.His birth history and developmental[ncbi.nlm.nih.gov]
Fidgeting
  • Not good at following instructions Unable or not good at completing step by step projects Unable to stay focused Unable to stay still, continuously fidget and move Constantly 'up to something' Talk excessively and energetically May act without thinking[symptoma.com]
  • Is Helpful for ADHD Patients, Study Shows Feb. 22, 2016 — Children often fidget or move when they are trying to solve a problem, and that movement may have a positive effect on children with ADHD, new research ... read more Link Between ADHD, Vision[sciencedaily.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]
  • Daydreaming, fidgeting, and persistent interruptions are all common behaviors in children.[healthline.com]
  • While every child may have occasional moments of daydreaming, fidgeting or forgetfulness, someone with ADHD experiences these often, in multiple settings and over a period of at least six months.[everettclinic.com]
Low Self-Esteem
  • ADHD can cause low self-esteem in the child and impair quality of life for the child and the family. It is known that ADHD is a chronic illness and that clinicians needed to use chronic illness principles in treating it.[intechopen.com]
  • They include: Chronic lateness and forgetfulness Anxiety Low self-esteem Problems at work Trouble controlling anger Impulsiveness Substance abuse or addiction Unorganized Procrastination Easily frustrated Chronic boredom Trouble concentrating when reading[webmd.com]
  • Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms.[mayoclinic.org]
Inattentive Behavior
  • ADD is characterized by a pattern of inattentive behavior, often combined with impulsivity and in some, hyperactivity.[psychcentral.com]
  • It is further categorized into three subtypes: behavior marked by hyperactivity and impulsivity but not inattentiveness; behavior that is marked by the reverse characteristics; and a mixed type.[azcourts.gov]
  • Some children exhibit mostly inattentive behaviors and others predominantly hyperactive-impulsive. But the majority of those with ADHD have a combination of both, which may make it very difficult for them to function in school.[childmind.org]
  • By comparison, school would seem even duller to a novelty-seeking kid living in the early 21st century than in previous decades, and the comparatively boring school environment might accentuate students’ inattentive behavior, making their teachers more[nytimes.com]

Workup

Workup includes a detailed history from the child, his/her parents and sometimes even questioning from teachers and friends of the affected child, along with a physical examination. Laboratory tests are conducted to rule out any hidden abnormality or disorder which may be the cause behind the child's symptoms. Other examinations may include:

  • Checking for otitis media and other ear disorders to rule out hearing problems. If the child is unable to hear properly, that will result in failure to follow orders and understanding instructions.
  • Eye examination: If the child is unable to see or read clearly, he may have trouble coping up with studies. 
  • Checking for any learning disabilities like dyslexia .
  • Testing for any other disease or abnormality that may result in impaired thinking and task execution.
  • CT scan of the brain may be conducted.

No single diagnostic test is available to confirm ADHD. The diagnosis is based on exclusion as well as on appropriate identification and judging of symptoms and signs.

Treatment

Where drug treatment is considered appropriate, methylphenidate, atomoxetine and dexamfetamine are recommended [8]. National Institute of Mental Health (NIMH)-funded research has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child's needs [9].

Cognitive behavioral therapy (CBT), behavior modification and intensive contingency treatment have been used. The latter two treatments are more effective than CBT in improving behavior and academic performance [10]. Psychotherapy may prove to be useful and support group sessions may also help in making the child understand his condition better and not feel alone in this.

Prognosis

A recent meta-analysis of follow-up studies of children found that [7]:

  • About 15% continued to have ADHD.
  • 65% had persistence of some symptoms and continuing functional impairment. 

There is no clear cure of ADHD yet, so prognosis varies from person to person. Sometimes, the child may grow out of this condition but this rarely happens.

 Complications

ADHD does not cause other disorders, but children suffering from this condition are more likely to have:

Etiology

The exact etiology of ADHD is unknown. Many factors have been implicated in the development of this disease, one of which is genetics. Recent studies of twins link genes with ADHD [3]. Many studies have shown that ADHD runs in families. Other factors include environmental triggers such as exposure to damaging radiation, toxins or undue stress. Maternal usage of alcohol, drugs or tobacco may also affect the child's developing brain. Lastly, idiopathic underdevelopment of the brain can cause ADHD to occur.

Epidemiology

Incidence

ADHD is estimated to affect about 6-7% of people aged 18 and under when diagnosed via DSM-5 criteria [2].

Sex

Studies show that it is almost 3 times more common in boys than in girls.

Race

ADHD has no known predilection to any race and occurs worldwide with no known statistical difference.

Sex distribution
Age distribution

Pathophysiology

Brain imaging studies have revealed that, in youth with ADHD, the brain matures at a normal pattern but is delayed, on average, by about 3 years [4]. This delay is most apparent in brain areas involved in generating thoughts and plans. More recent studies have found that the outermost layer of the brain, the cortex, shows delayed maturation overall [5].

Current models involve the mesocorticolimbic dopamine pathway and the locus ceruleus-nonadrenergic system [6]. So, the damage is clearly due to underdevelopment of the brain, be it just the prefrontal cortex, the posterior parietal cortex or the dopamine pathways. Due to this delayed or impaired development of the brain, the child appears to be slow, mentally impaired and 'abnormal'.

Prevention

There is no exact preventive measure known but the following factors may contribute in the prevention of this condition:

  • Maternal health care
  • Proper diet
  • Protection from exposure to any environmental toxin
  • Providing a safe and secure social and home environment to the child

Summary

Attention deficit hyperactivity disorder (ADHD) is a chronic condition that includes a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behaviour. ADHD is described as the most common neurobehavioural disorder of childhood [1], due to improper or delayed brain development. It occurs in children and may persist in adults as well.  

According to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) of the American Psychiatric Association there are three different types of ADHD, depending on the presentation of the affected individual:

  • Predominantly inattentive presentation
  • Predominantly hyperactive-impulsive presentation
  • Combined presentation

Patient Information

Attention deficit hyperactivity disorder (ADHD) is a common disorder affecting children and often goes undiagnosed when parents simply label the child as 'simpleminded or dull' when in reality the child is suffering from ADHD. A child with ADHD needs to be given special care and support with which he/she may lead a normal health life. Contact should be made with a specialist if your child shows symptoms including:

  • Lack of attention to details
  • Memory problems, trouble remembering most things 
  • Easily distracted
  • Careless behavior, frequently lose possessions, mix up things, etc.
  • Not good at following instructions 
  • Difficulty focusing attention
  • Problems organizing and completing a task  
  • Unable to stay focused
  • Unable to stay or sit still, continuously fidget and move
  • Constantly 'up to something'
  • Talk excessively and energetically 
  • May act without thinking 
  • Impatience 
  • Mood swings

References

Article

  1. American Academy of Paediatrics, author Clinical Practise Guideline:Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Peadiatrics 2000;105:1158-1170
  2. Willcutt EG. The prevalence of DSM-IV ADHD: a meta-analytic review. Neurotherapeutics 2012 9(3):430-9. 
  3. The ADHD Molecular Genetics Network. Reports from the third international meeting of the ADHD molecular genetics network. American Journal of Medical Genetics 2002; 272-277
  4. Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, et al. Attention Deficit/Hyperactivity Disorder is characterised by a delay in cortical maturation. Proc Natl acad Sci USA 2007 Dec 4;104(49):19649-54. 
  5. Shaw P, Malek M, Watson B, Sharp W, Evans A, Greenstein D. Development of cortical surface area and gyrification in attention deficit/hyperactivity disorder. Biol Psychiatry. 2012 Aug 1;72(3):191-7. 
  6. Malenka RC, Nestler EJ, Hyman SE. 2009. Chapters 10 and 13. In Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience. 2nd ed. New York: McGraw Hill Medical, pp 266, 318-323 
  7. Faroane SV, Biederman J, Mick E;The age-dependent decline of ADHD:a Psychol Med.2006 Feb:36(2):159-65
  8. Attention-deficit Hyperactivity Disorder-ADHD. 'Methylphenidate, atomoxetine and dexamfetamine'; NICE 2006
  9. The MTA Cooperative Group. A 14-month randomised clinical trial of treatment strategies for attention deficit-hyperactivity disorder. Arch Gen. Psychiatry. 1999 Dec;56(12):1073-86. PMID 10591283
  10. Management of attention deficit and hyperkinetic disorders in children and young people; Scottish Intercollegiate Guidelines Network- SIGN (Oct 2009)

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Last updated: 2018-06-21 17:11