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Attention Deficit and Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting preschoolers, children, adolescents and adults around the world. Symptoms of ADHD include inattention (not being able to keep sustained attention/focus), hyperactivity (excessive movements/activities that is not fitting to the setting) and impulsivity (hasty acts that occur without thought).

Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.

Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm to themselves or others; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

An estimated 5 percent of children. ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It can also affect adults. It is more common among boys than girls.

Symptoms and signs

ADHD is diagnosed as one of three types: inattentive type, hyperactive/impulsive type or combined type. A diagnosis is based on the symptoms that have occurred over the past six months.

Inattentive type – six (or five for people over 17 years) of the following symptoms occur frequently:

  • Doesn’t pay close attention to details or makes careless mistakes in school or job tasks.
  • Has problems staying focused on tasks or activities, such as during lectures, conversations or long reading.
  • Does not seem to listen when spoken to (i.e., seems to be elsewhere).
  • Does not follow through on instructions and doesn’t complete schoolwork, chores or job duties (may start tasks but quickly loses focus).
  • Has problems organizing tasks and work (for instance, does not manage time well; has messy, disorganized work; misses deadlines).
  • Avoids or dislikes tasks that require sustained mental effort, such as preparing reports and completing forms.
  • Often loses things needed for tasks or daily life, such as school papers, books, keys, wallet, cell phone and eyeglasses.
  • Is easily distracted.
  • Forgets daily tasks, such as doing chores and running errands. Older teens and adults may forget to return phone calls, pay bills and keep appointments.

Hyperactive/impulsive type – six (or five for people over 17 years) of the following symptoms occur frequently:

  • Fidgets with or taps hands or feet, or squirms in seat.
  • Not able to stay seated (in classroom, workplace).
  • Runs about or climbs where it is inappropriate.
  • Unable to play or do leisure activities quietly.
  • Always “on the go,” as if driven by a motor.
  • Talks too much.
  • Blurts out an answer before a question has been finished (for instance may finish people’s sentences, can’t wait to speak in conversations).
  • Has difficulty waiting his or her turn, such as while waiting in line.
  • Interrupts or intrudes on others (for instance, cuts into conversations, games or activities, or starts using other people’s things without permission). Older teens and adults may take over what others are doing.

There is no lab test to diagnose ADHD. Diagnosis involves gathering information from parents, teachers and others, filling out checklists and having a medical evaluation (including vision and hearing screening) to rule out other medical problems.

The Causes of ADHD

No specific cause is found till date. There is evidence that genetics contribute to ADHD. For example, three out of four children with ADHD have a relative with the disorder. Other factors that may contribute to the development of ADHD include being born prematurely, brain injury and the mother smoking, using alcohol or having extreme stress during pregnancy

Diagnosis is made when several symptoms are present by age 12 years and the symptoms should be present in at least 2 settings (e.g. home and school). Diagnosis is completely based of detailed history and clinical evaluation.

Course and prognosis

40% of the cases remit at puberty usually between ages 12-20 years. In 60 % of the cases some symptoms persist in the adulthood. Those whose symptoms persist in adulthood can develop conduct disorder, anti-social behavior, substance use disorders and mood disorders.

Treatment

Although there is no cure for ADHD, current available treatments may help reduce symptoms and improve functioning. ADHD is commonly treated with combination of medication, education or training and psycho-therapy.

Medication

For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to sustain attention, work, and learn. The first line of treatment for ADHD is stimulants.

Stimulants:

Stimulants are considered to be first choice agents for treatment of ADHD. Methylphenidate and amphetamine salts are widely used.

Common side effects include headache, nausea, insomnia and initial increase in hyperactivity. Growth suppression can occur in some children for which ‘Drug Holidays’ are given on weekends or summer

Non-Stimulants:

These medications take longer to start working than stimulants, but can also improve attention, and impulsivity in a children or adults with ADHD. Doctors may prescribe a non-stimulant if a person had severe side effects from stimulants, if a stimulant was not effective, or in combination with a stimulant to increase effectiveness. Atomoxetine and guanfacine are commonly used non-stimulants drugs

Common side effects include reduced appetite, abdominal discomfort, dizziness and irritability.

Antidepressants:

Although antidepressants are not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Antidepressants tricyclics, sometimes are used because they, like stimulants, affect the brain chemicals norepinephrine and dopamine.

There are many other drugs also to treat ADHD.

Therapy

There are different therapies that have been tried for ADHD, but research shows that only therapy may not be effective in treating ADHD symptoms. However, combination of therapy with pharmacotherapy may help patients and families better cope with daily challenges.

Psycho-social interventions include psychoeducation, academic organization skills remediation, parent training, behavioral modifications in classroom and at home, cognitive behavioral therapy and social skills training.

A common goal of therapy is to help parents recognize and promote the notion that child is not doing it purposefully and is still capable of doing many good things and improving his academic performance and self esteem. Most parental training is based on helping them develop usable behavioral interventions with positive reinforcement that target both social and academic behaviors.

Parents and teachers can help children and teens with ADHD stay organized and follow directions with tools such as keeping a routine and a schedule, organizing everyday items, using homework and notebook organizers, and giving praise or rewards when rules are followed.

Education and Training

Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond empathically to their child’s behavior.

Support groups can help parents and families connect and share their experiences with others who have similar problems and concerns.

Adding behavioral therapy, counseling, and practical support can help people with ADHD and their families to better cope with everyday problems.

Teachers and school teachers can inform parents or psychiatrist about ADHD if they found any symptoms in child.

ADHD in Adults

Many adults with ADHD do not realize they have the disorder. A evaluation includes a review of past and current symptoms and use of adult rating scales or checklists. Adults with ADHD are treated with medication, psychotherapy or a combination. Behavior management strategies, such as ways to minimize distractions and increase structure and organization, and involving immediate family members in the management can also be helpful.

Treatment

 

Behavioral therapy and medication can improve the symptoms of ADHD. Combination of behavioral therapy and medication works best for most people, particularly those with moderate to severe ADHD.