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    Attention Deficit Hyperactivity Disorder (Attention Deficit Disorder with Hyperactivity)

    Primary Laos2[1]

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

    Attention Deficit Hyperactivity Disorder is the consequence of the following process: endocrine.

    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

    Entire body system
    School Problem
    • If it is not treated correctly, ADHD may lead to: Drug and alcohol abuse Not doing well in school Problems keeping a job Trouble with the law One third to one half of children with ADHD continue to have symptoms of inattention or hyperactivity-impulsivity[nytimes.com]
    • If untreated, these challenges can lead to school problems, social isolation, and tumultuous relationships with family members.[medicinenet.com]
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  • Face, Head & Neck
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  • neurologic
    Difficulty Concentrating
    • 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]
    • Most students and adults will go through periods of restlessness and inattentiveness, with difficulty concentrating, focusing, and completing work.[hampshire.edu]
    • A child with these characteristics typically demonstrates the following signs: Inattention Has difficulty concentrating Has unrelated thoughts Has problems focusing and sustaining attention Appears to not be listening Performance depends on task May have[asha.org]
    • Health care professionals may use any of the following terms when describing a child (or an older person) who is overactive and has difficulty concentrating: Attention deficit disorder Attention deficit hyperactivity disorder Hyperkinetic disorder Hyperactivity[medicalnewstoday.com]
    • Attention-deficit/hyperactivity disorder (ADHD) , a behavioral syndrome characterized by inattention and distractibility, restlessness, inability to sit still, and difficulty concentrating on one thing for any period of time.[britannica.com]
    Excessive Talking
    • 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]
    • 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]
    • talking blurting out answers before hearing the full question difficulty waiting for a turn or in line problems with interrupting or intruding 3. a combined type , a combination of the other two type, is the most common Although it can be challenging[kidshealth.org]
    • talking Difficulty waiting turns Blurting out answers too quickly Interruption or intrusion of others Hyperactive and impulsive symptoms typically are observed by the time the child reaches four years of age and increase during the next three to four[uptodate.com]
    Excitement
    • Price: 115.00 Ages: 5 through 18 Testing Time: 15 to 20 minutes Administration: Individual The Scales for Diagnosing Attention Deficit/Hyperactivity Disorder (SCALES) is an exciting new assessment tool that accurately identifies and evaluates Attention-Deficit[proedinc.com]
    • ADHD in children is completely different from normal childhood excited and boisterous behavior.[medicalnewstoday.com]
    • Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited.[kidshealth.org]
    • ., a project for work) Creates sense of productivity by reducing items on a to-do list but defers a more difficult project Juggling Taking on new, exciting projects and feeling busy without completing projects already started It is easier to become motivated[clevelandclinicmeded.com]
    • The lives of children with ADHD may be complicated by frequently getting in trouble and difficulty making and keeping friends since they can't focus, as well as due to having a lack of restraint, a tendency toward excitability and engaging in impulsive[medicinenet.com]
    Forgetful
    • Forgetfulness Kids with ADHD may be forgetful in daily activities.[healthline.com]
    • Short attention span for age, difficulty listening to others, difficulty attending to details, easily distracted, forgetfulness, poor study and organizational skills for age.[bswhealth.com]
    • Children with ADHD often have trouble with the following: Paying attention Sitting still Talking out of turn Being forgetful or loosing things Acting without thinking about consequences There is no cure for ADHD, but the symptoms can be managed.[yalehealth.yale.edu]
    • 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]
    Hyperactivity
    • British Dictionary definitions for attention deficit hyperactivity disorder noun 1. a form of attention deficit disorder in which hyperactivity is a prominent symptom ADHD attention deficit hyperactivity disorder in Science attention deficit hyperactivity[dictionary.com]
    • […] type F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.2 Attention-deficit hyperactivity disorder, combined type F90.8 Attention-deficit hyperactivity disorder, other type F90.9 Attention-deficit hyperactivity disorder[icd10data.com]
    • But inattention, impulsivity, and hyperactivity are also signs of attention deficit hyperactivity disorder (ADHD or ADD).[helpguide.org]
    Irritability
    • […] 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]
    • Possible side effects include decreased appetite, stomachache, irritability, and insomnia.[kidshealth.org]
    • Cons: May be habit-forming; can cause slowed growth, loss of appetite and weight, irritability, and restlessness.[time.com]
    • Talk with a doctor if you see any of these side effects while taking stimulants: decreased appetite sleep problems tics (sudden, repetitive movements or sounds); personality changes increased anxiety and irritability stomachaches headaches Non-stimulants[nimh.nih.gov]
    • "I rarely get irritated."[mentalhealth.com]
    Memory Impairment
    • Memory Impairment Sociability (Extraversion) Detachment Enthusiastic, Assertive vs.[mentalhealth.com]
    Screaming
    • During a class visit to the zoo, Saorla, who has trouble transitioning from one activity to another, balked at moving from one exhibit with the rest of the children and threw a classic “big blowout” tantrum—kicking and screaming—while her mother hauled[time.com]
    Tantrums
    • Younger children may have temper tantrums . 5.[healthline.com]
    • They don’t wait their turn, interrupt others, are easily frustrated, take wild risks, and their emotions can spill over like water at a rolling boil: They may be hot-headed, lash out violently, or have temper tantrums.[time.com]
    • […] waiting to be called on or hear the whole question Intrudes on other people’s conversations or games Often interrupts others; says the wrong thing at the wrong time Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums[helpguide.org]
    • For example, children can spend hours in front of a screen playing video games, but they may have trouble finishing even simple homework assignments, or they may throw tantrums and refuse to do chores or school work at home.[my.clevelandclinic.org]
    • They are characterized by antisocial behaviors such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, and stealing.[en.wikipedia.org]
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  • psychiatrical
    Abnormal Behavior
    • The social construct theory of ADHD suggests that because the boundaries between "normal" and "abnormal" behavior are socially constructed, (i.e. jointly created and validated by all members of society, and in particular by physicians, parents, teachers[en.wikipedia.org]
    Addictive Behavior
    Distractibility
    Fidgeting
    • 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]
    • Avoids or dislikes tasks that require sustained mental effort (such as schoolwork) Often loses toys, assignments, pencils, books, or tools needed for tasks or activities Is easily distracted Is often forgetful in daily activities Hyperactivity Symptoms Fidgets[mentalhealth.gov]
    • […] with hands or squirms when in his or her seat; fidgeting excessively 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[stanfordchildrens.org]
    • Hyperactivity means a person seems to move about constantly, including situations in which it is not appropriate when it is not appropriate, excessively fidgets, taps, or talks.[cincinnatichildrens.org]
    • Doesn't follow through on obeying instructions Is disorganized Loses important things Forgets things Doesn't want to do things that require ongoing mental effort Has trouble understanding information quickly and accurately Signs of hyperactivity: Often fidgets[babycenter.com]
    Impulsivity
    • 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]
    • Trait impulsivity and the externalizing spectrum.[journals.plos.org]
    • Inattention, hyperactivity (restlessness in adults), disruptive behavior, and impulsivity are common in ADHD.[en.wikipedia.org]
    • Inattentive Hyperactive-impulsivity Inattention and hyperactivity / impulsivity are the key behaviors of ADHD.[cincinnatichildrens.org]
    • Hyperactive and impulsive, but able to pay attention.[helpguide.org]
    Inattentive Behavior
    • 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]
    Low Self-Esteem
    • ADHD can cause low self-esteem in the child and impair quality of life for the child and the family.[intechopen.com]
    • If it is untreated, teens with ADHD have a higher chance of school failure and dropout, low self-esteem, demoralization, substance or alcohol abuse and delinquency (breaking the law).[seattlechildrens.org]
    • Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school.[mayoclinic.org]
    • These frustrations and difficulties can lead to low self-esteem as well as friction and stress for the whole family.[helpguide.org]
    • They may feel isolated, frustrated by school failures and social problems, and have low self-esteem .[kidshealth.org]
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  • 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:

    Complications

    Adult Attention Deficit Disorder
    • The World Health Organization (WHO) Adult Self-Report Screener (ASRS) for Adult Attention Deficit Disorder (ADD) includes six questions rated on a scale from 0 to 4 (0 never, 1 rarely, 2 sometimes, 3 often, 4 very often).[clevelandclinicmeded.com]
    Bipolar Disorder
    • ADHD symptoms may also overlap with other mental health problems, including anxiety, depression, bipolar disorder, and alcohol or drug abuse.[hampshire.edu]
    • Learning disabilities Oppositional defiant disorder: refusal to accept directions or authority from adults or others Conduct disorder, persistent destructive or violent behaviors Anxiety and depression Obsessive-compulsive disorder Bipolar disorder Tourette's[nami.org]
    • ADHD and mental health disorders Adults with ADHD are likely to have an anxiety disorder, depression, bipolar disorder, or other comorbid psychiatric disorder.[adaa.org]
    • A child with ADHD may also have other psychiatric disorders such as conduct disorder, anxiety disorder, depressive disorder, or bipolar disorder.[aacap.org]
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  • 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

    Self-assessment

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    References

    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)

    • Abuse and toxicity of methylphenidate - W Klein-Schwartz - Current Opinion in Pediatrics, 2002 - journals.lww.com
    • 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 psychoanalytic perspective on attention-deficit/hyperactivity disorder - K Gilmore - Journal of the American Psychoanalytic Association, 2000 - apa.sagepub.com
    • Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type - J Biederman, E Mick - American Journal of , 2000 - Am Psychiatric Assoc


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