Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder, ADHD as commonly known, is a neurobehavioral disorder of childhood. It is with increasingly diagnosed in adults too. Persons affected with ADHD are overactive, have impulsivity, forgetfulness and have poor ability to attend to task. According to CDC about 4 million people are affected with this disorder in the age group of 4-17 years with M: F of 4:1.3-5% of them being school going children. Co-morbid conditions associated with ADHD are anxiety disorder, mood disorder, learning disorder. In adolescents age group it is associated with substance abuse.

Etiology

The cause of ADHD is unknown. Genetic and environmental factors during fetal brain development are proposed to cause ADHD. The development of certain areas of brain is decreased in children with ADHD as proved by imaging studies. Other proposed causative agents are:

• Maternal smoking
• Preterm delivery
• Low birth weight
• Birth injuries
• Increased hours of television watching during early developmental period

Signs & Symptoms

The major symptoms of ADHD are inattention, hyperactivity and impulsivity. The associated warning symptoms are disorganized behavior, excessive talking, failure to respond to instructions, leaving home work, chores, projects unfinished, having problems in attending and responding to details.

Symptoms of inattention

• Have difficulty sustaining attention

• Making careless mistakes
• Does not listen
• Does not follow through on tasks
• Have difficulty getting organized

• Avoids sustained mental effort
• Often loose things
• Gets distracted easily

• Is often forgetful

Symptoms of Hyperactivity

• Often talking excessively
• Often remain out of his/her seat
• Running and climbing excessively
• Often have difficulty playing quietly
• Always on the go as if run by a motor

Symptoms of impulsivity

• Often blurting out answers
• Often having difficulty awaiting his/her turn
• Often interrupting or intruding others

Diagnosis

Diagnostic criteria for ADHD need at least six symptoms of inattentiveness group, six from hyperactivity/impulsivity cluster or both. To diagnose ADHD, these symptoms should have started before the age of 7 years and should be present for at least 6 months duration and should be noticed in two different settings for example at home and at school. They must exceed what would be expected for the child's developmental age and must impair child's academic and social function.

Treatment

There is no cure for ADHD and symptoms can only be controlled. The two components of treatment of ADHD are medical and psychological. Treatment should be started with explaining the outcome of the disease to parents. Medications will only aid in the management. Involvement of the child's immediate environment like parents, teachers, and school is very important. Even partial improvement should be accepted and appreciated by the parents. Training program involving parents, educational method modification and behavioral therapy are important in the management of children with ADHD.

Medical management involves usage of stimulant medications and antidepressants with varied beneficial results. Combined medical and behavioral therapy are very effective. Behavioral therapy helps by

• Reorganizing the environment
• Giving clear instructions
• Developing a system that rewards appropriate behavior and has negative consequence for inappropriate behavior.

Alternative methods of treatment used in treating children with ADHD are the use of megavitamins, electroencephalographic biofeedback, optometric vision tracing, chiropractic manipulation, herbal remedies and dietary restriction of sugar and food additives.

Outcome

• 50% function well into adulthood
• Remaining continue to have symptoms

• 50-80% of those persisting to have symptoms have delinquent and antisocial behavior in adult life.

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