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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
School Problem
  • ADHD may lead to: Drug and alcohol use Not doing well in school Problems keeping a job Trouble with the law One third to one half of children with ADHD have symptoms of inattention or hyperactivity-impulsivity as adults.[nlm.nih.gov]
  • School problems include difficulties comprehending written and spoken language, poor vocabulary, word-finding difficulties and difficulties using context to help with the comprehension of reading.[addiss.co.uk]
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
  • Conclusions: ADHD children that were medicated exhibited similar dental caries prevalence and periodontal health status.[ncbi.nlm.nih.gov]
Short Arm
  • Abstract 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
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]
  • RECENT FINDINGS: 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]
  • Girls are more likely to be inattentive without being hyperactive or impulsive, compared with boys. Girls and boys share the same familial risk patterns, as well as similar, although not identical, comorbidity or impairment patterns.[ncbi.nlm.nih.gov]
  • 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]
Distractibility
  • Others are highly distractible, forgetful, or inattentive. Some appear distracted by every little thing and don't seem to learn from their mistakes. Many of these children disregard rules, even when they are punished repeatedly.[citeseerx.ist.psu.edu]
  • 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]
  • 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]
  • 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]
  • Signs and symptoms of ADHD: Difficulty concentrating or keeping attention Being Easily Distracted Irresponsibility Difficulty in social situations Being hyperactive Trouble listening to instructions National Institute of Mental Health (2008).[liberty.edu]
Fidgeting
  • 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]
  • 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]
  • 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]
  • Many children with ADHD : Are in constant motion Squirm and fidget Make careless mistakes Often lose things Do not seem to listen Are easily distracted Do not finish tasks To diagnose ADHD, your child should receive a full physical exam, including vision[webmd.com]
  • Daydreaming, fidgeting, and persistent interruptions are all common behaviors in children.[healthline.com]
Low Self-Esteem
  • Continued In addition to symptoms of inattention and/or impulsiveness, adults with ADHD may have other problems, including: Chronic lateness and forgetfulness Anxiety Poor organizational skills Low self-esteem Employment problems Short temper Difficulty[webmd.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]
  • Her marriage was troubled, and she had low self-esteem, says Clionsky, the cofounder of the ADD Center of Western Massachusetts in Springfield.[web.archive.org]
Short Attention Span
  • Inattentiveness The main signs of inattentiveness are: having a short attention span and being easily distracted making careless mistakes – for example, in schoolwork appearing forgetful or losing things being unable to stick to tasks that are tedious[nhs.uk]
  • Short attention span for age, difficulty listening to others, difficulty attending to details, easily distracted, forgetfulness, poor study and organizational skills for age. Impulsivity.[bswhealth.com]
  • Attention-deficit/hyperactivity disorder (ADHD) describes individuals who have problems due to a short attention span, impulsivity, and/or hyperactivity. ADHD occurs in 5 to 8 percent of school-age children and about 2 to 4 percent of adults.[chop.edu]
  • It's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest. The same is true of hyperactivity.[mayoclinic.org]
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]
  • Three subtypes of attention deficit hyperactivity disorder (predominantly inattentive, predominantly hyperactive-impulsive, and combined types) were distinguished on the basis of the degree of deviance on separate dimensions of inattention and hyperactivity-impulsivity[ncbi.nlm.nih.gov]
  • Abstract Attention-deficit/hyperactivity disorder is a neurobiological syndrome with an estimated prevalence among children and adolescents of 5%.[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]
Forgetful
  • Others are highly distractible, forgetful, or inattentive. Some appear distracted by every little thing and don't seem to learn from their mistakes. Many of these children disregard rules, even when they are punished repeatedly.[citeseerx.ist.psu.edu]
  • Inattentiveness The main signs of inattentiveness are: having a short attention span and being easily distracted making careless mistakes – for example, in schoolwork appearing forgetful or losing things being unable to stick to tasks that are tedious[nhs.uk]
  • 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]
  • 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]
Irritability
  • 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.[ncbi.nlm.nih.gov]
  • 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]
  • […] 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]
  • 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]
Excitement
  • Emotional dysregulation (ED) is a dysfunction in modifying an emotional state in an adaptive and goal oriented way, with excitability, ease anger, and mood lability.[ncbi.nlm.nih.gov]
  • Royal College of Psychiatrists ( 2004b ) The restless and excitable child. In Mental Health and Growing Up ( 3rd edn ) (eds Rose, G. & York, A. ), p. 1. London : Royal College of Psychiatrists ( ).[dx.doi.org]
  • “We’re pretty excited about the possibility that some brain measurement would tell us which child or adult is most likely to benefit from a treatment.”[mcgovern.mit.edu]
  • Other Weekly Threads Join us for our other exciting weekly threads! Win Wednesday - Come together and celebrate our accomplishments! Finish It Friday - Get one more thing done before the weekend![reddit.com]
  • "We are excited to offer physicians and families a potential new option in the treatment of ADHD and are working closely with the FDA to obtain final approval."[phx.corporate-ir.net]
Memory Impairment
  • The present meta-analysis examined underlying mechanisms that may lead to long-term memory impairments in adult ADHD.[ncbi.nlm.nih.gov]
  • A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry , 44 , 377–384. doi: 10.1097/01.chi.0000153228.72591.73 .[dx.doi.org]
  • Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorder. Journal of Clinical and Experimental Neuropsychology 28, 1073 – 1094. Mathers, ME ( 2006 ).[doi.org]
  • Doing the think/no-think and go/no-go tasks concurrently leads to memory impairment of unpleasant items during later recall. Frontiers in Psychology, 3, 1–6. . Google Scholar Holtzman, J. B., & Bridgett, D. J. (2017).[doi.org]
  • Domingo and Maria Teresa Colomina, Chronic exposure to chlorpyrifos triggered body weight increase and memory impairment depending on human apoE polymorphisms in a targeted replacement mouse model, Physiology & Behavior, 10.1016/j.physbeh.2015.03.006,[doi.org]

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