ATTENTION DEFICIT & HYPERACTIVITY DISORDER (ADHD)

Dr. Rismarini, SpA

Description of the problem :

ADHD is a behavioral syndrome that appears early in the child life, typically persist throughout childhood and adolescence.

It is associated with a triad of symptoms: - hyperactivity, - inattentiveness, and - impulsivity

Epidemiology :
Affect 4 10 % of elementary schoolaged children Up to 20 % in lower socioeconomic status Male to female ratio = 6 : 1

Etiology : ?
There are multiple causes : Genetic factors Differences in the brain (neuroanatomy & neurotransmiters) Environmental factors : Parental psychopathology, Low socioeconomic status, Poor monitoring of behavior, A punitive approach to discipline

Clinical manifestation
ADHD afflicted children display various behavior indicative of problem with Attention Hyperactivity Impulsivity

Diagnostic criteria
A. B.

C. D.

E.

Inattention or hyperactivity-impulsivity Some symptoms that caused impairments were present < age 7 yr Impairment are present in > 2 setting Clinically significant impairment in social, academic or occupational Doesnt occur during the course of a pervasive disorder, schizophrenia or other psychotic disorder

1. Inattention

At least six symptoms of inattention, persisted at least 6 months, That is maladaptive and inconsistent with developmental level

Inattention.
Often fails to give close attention to details, makes careless mistaken in schoolwork, work and other activity Often has difficulty sustaining attention in tasks or play activity Often doesnt seem to listen Often doesnt follow through on instruction and fail to finish schoolwork, chores, or duties

Inattention

Often has difficulties organizing tasks and activity Often avoids, expresses reluctance about, or has diffuculties engaging in tasks Often loses things necessary for tasks or activity Often easily distructed by extraneous stimuli Often forgetful in daily activities

2. Hyperactivity-impulsivity

At least 5 simptoms of hiperactivityimpulsivity, persisted for at least 6 months That is maladaptive ans inconsistent with developmental level

Hyperactivity

Often fidgets with hands or feet or squirms in seat Leaves seat in classroom or in other situations Often runs about or climbs excessively Often has difficulty playing or engaging in leisure activity quietly Is always on the go or act as if driven by a motor Often talks excessively

Impulsivity

Often blurts out answers to questions before the questions have been completed Often has difficulty waiting in lines or awaiting turn in games or group situations Often interrupts or intrudes on others

Clasification :

ADHD predominantly inattentive type ADHD predominnantly hyperactive impulsive type ADHD combined type

Differential diagnosis

Pervasive developmental disorder (autisme, autistic-like disorder) Major affective disorder (depression) Reaction to stress Hyperthyroidisme Iron deficiency anemia Lead toxicity Hearing loss

Treatment
1.Medication : CNS stimulant Methylphenidate 0,3 mg/kg/dose, twice daily, increase by 0,15 mg/kg/dose Dextroamphetamine 0,15 mg/kg/dose, twice daily, increase by 0,15 mg/kg/dose Pemoline 37,5 mg in AM

Treatment

Psychological therapy Teaching effective behavioral management skills to parents & teachers Child and parent counseling Group social skills training Family therapy, dinamic Family therapy, communication skills Child psychotherapy

Prognosis

50% of these children function well in adulthood The remaining continue to exhibit symptoms of inattention and impulsivity Delinquent behavior during adolescence and later antisocial personality (5080%) Alcohol abuse & drug use are quite prevalent

Poor outcomes are most common in children who exhibit defiance and agression toward adult, have poor relationships, Below average cognitive function