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.

The defining behaviors fall under the general catagories
of :
- hyperactivity,
- inattentiveness, and
- impulsivity
Epidemiology :
4 6% of elementary school-aged 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 (neuroanatamy &
neurotransmiters)
Environmental factors :
Parental psychopathology,
Low socioeconomic status,
Poor monitoring of behavior,
A punitive approach to discipline
Diagnostic criteria
A. Inattention or hyperactivity-impulsivity
B. Some symptoms that caused impairments
were present < age 7 yr
C. Impairment are present in > 2 setting
D. Clinically significant impairment in social,
academic or accupational
E. Doesnt occur during the course of a
pervasive disorder, schizophrenia or other
psychotic disorder

1. Inattention
At least six symptoms of inattetion, 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 hiperactivity-
impulsivity, 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