Attention Deficit Hyperactivity Disorder

ADHD is characterized by 3 core symptoms:

1. Inattention
2. Hyperactivity &
3. Impulsiveness

DSM V recognizes 3 subtypes:

1. Combined subtype
2. Inattentive subtype
3. Hyperactive – impulsive subtype.

Prevalence:

The worldwide prevalence of ADHD : 5% in children & 2.8% in adults.

⭐Aetiology:

1. Genetics: 80% cases are genetically inherited. Risk is 2-3 times more in siblings

2. Low Birth-Weight babies.

3. Babies born to mothers who used drugs, alcohol or tobacco during pregnancy.

⭐Diagnosis:

1. Symptoms should be at developmentally inappropriate levels.
2. Symptoms should be present for at least 6 months.
3. Symptoms start before age 7.

⭐Clinical Feactures:

👉Inattention:

Careless, fails to sustain attention, appears not to listen, fails to finish tasks, poor self organization & easily distracted.

👉Hyperactivity:

Fidgets with hands or feet, leaves seat in class, can not play quietly, ‘always on the go’.

👉Impulsiveness:


Talks  excessively, blurts out answers, can not await turn & interrupts others

⭐Differential Diagnosis:

1. Age – appropriate behaviour in active children.
2. Attachment Disorder.
3. Hearing Impairment.
4. Learning Difficulty.
5. A High IQ child challenged in mainstrem school.
6. Behavioural Disorder.
7. Anxiety Disorder
8. Medication side – effects(e.g. Antihistamines).

⭐Comorbidity:

ADHD is highly comorbid with 50-80% having a comorbid disorder.

1. Specific learning Disorders.
2. Motor – co-ordination problems.
3. Autism spectrum Disorder.
4. Tic Disorders.
5. Conduct Disorder.
6. ODD
7. Substance Abuse
8. Anxiety/ Depression/ Bipolar Disorder.

Problems associated with ADHD:

a) Short-Term:

● Sleep Problems.                      
● Low self-esteem.                        
● family & peer relationship problems.                       
● Reduced academic achievements.                       
● Increased risk of accidents.

b) Long-Term:

● Reduced Academic & employment success.                        
● decreased Criminal Activity.                         
● Antisocial Personality Disorder.                         
● ADHD symptoms may persist  into adulthood:
*Impulsivity-hyperactivity remits early
*Inattention often persists.

Poor Prognosis:

• Social deprivation.
• High expressed emotions.
• Parental mental illness.                    
• Conduct Disorder
• Learning Disorder                    
• Language Disorder
• Predominantly Hyperactive – Impulsive symptoms.

Management:

Psycho-education:

The main focus is on training parents about strategies and skills to improve child behavior, self-control and self esteem.

PLAY & TALK THERAPY helps the child to talk about their feelings and play games that teaches them to wait for their turns.

STRESS MANAGEMENT TECHNIQUES helps parents to deal with frustration and respond calmly.

Behavioural Intervention:  

👉encourage realistic expectations.                 
👉reinforcement of desired behaviours.

Medications: 

  ° Methylphenidate 
  ° Atmoxetine 
  ° Dexamfetamine

When improvement has occured, treatment can be discontinued at intervals.

Treat comorbidity.

Reference:

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