Attention-deficit/hyperactivity disorder (ADHD)

Notes

## Basic introduction

  • Attention-deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate symptoms of inattention, hyperactivity, and impulsivity.
  • The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies ADHD into three categories[d]:
  • Predominately inattentive presentation (ADHD-PI)
  • Predominately hyperactive-impulsive presentation (ADHD-HI)
  • Combined presentation (ADHD-C)
  • Possible causes for ADHD include:
  • Neurobiological factors like abnormalities in the frontal striatal circuitry of the brain
  • Neurotransmitters disorders such as dopamine and norepinephrine
  • Genetic factors (ADHD runs in families)
  • Comorbid psychological disorders to ADHD include:
  • Oppositional defiant disorder (ODD)
  • Conduct disorder (CD)
  • Anxiety disorders
  • Mood disorders

## Statistics

  • The global prevalence of ADHD is 5.29% - 7.1%[b][c]
  • A study carried out in Starehe, Nairobi, Kenya, established that 17.8% of the children had ADHD symptoms with the male child: female child ratio of 3:1[a]
  • In about 80% of children with ADHD, symptoms persist into adolescence and sometimes into adulthood[d]
Symptoms

## The triad of ADHD are:

  • Inattention

    Inability to:

  • Follow through various tasks
  • Listen
  • Maintain attention in play or other activities
  • Provide close attention to detail
  • Impulsivity
  • Hyperactivity
  • Excessive fidgetiness
  • Interruption or intrusion of others
  • Excessive talking

## People suffering from ADHD are    …..likely to have:

  • Cognitive deficits
  • Depression
  • Impaired academic performance
  • Intellectual deficits
  • Lower occupational status
  • Marital problems
  • Medical and physical issues
  • Poor relationships
  • Relatives who suffer due to their behavior
  • Impairment of speech and language
  • Tendency to abuse substance
  • Tendency to commit crime
Diagnosis
  • Clinical review as per the DSM5 guidelines
Differential
  • Anxiety Disorder
  • Asperger Syndrome
  • Bipolar Affective Disorder
  • Conduct Disorder
  • Depression Dysthymic Disorder
  • Hyperthyroidism Posttraumatic Stress Disorder
  • Learning Disorder
  • Nightmare Disorder
  • Obsessive-Compulsive Disorder
  • Pediatric Bipolar Affective Disorder
  • Separation Anxiety
  • Sleep Disorders
Prevention

None is currently known

Reference
  1. Kanyithia, P. M. (2011). Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in primary school children in Starehe Division in Nairobi Province, Kenya (Doctoral dissertation, University of Nairobi, Kenya)
  2. Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003). The worldwide prevalence of ADHD: is it an American condition. World psychiatry, 2(2), 104-113
  3. Biederman, J., Wilens, T., Mick, E., Faraone, S. V., Weber, W., Curtis, S., ... & Soriano, J. (1997). Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 36(1), 21-29.
  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Association; 1994
  5. Nigg, J. T., Blaskey, L. G., Huang-Pollock, C. L., & Rappley, M. D. (2002). Neuropsychological executive functions and DSM-IV ADHD subtypes. Journal of the American Academy of Child & Adolescent Psychiatry, 41(1), 59-66.
  6. Nomura, K., Okada, K., Noujima, Y., Kojima, S., Mori, Y., Amano, M., ... & Fukumoto, R. (2014). A clinical study of attention-deficit/hyperactivity disorder in preschool children—prevalence and differential diagnoses. Brain and Development, 36(9), 778-785.
Management
  • Stimulant medications (most effective intervention) and they include dextroamphetamine and methylphenidate
  • Tabs Methylphenidate 20-30 mg daily in two or three doses. Children: Above six years, initially 5mg once or twice daily with gradual increments of 5-10mg weekly. Max 60mg / day.  Below 6yrs, not recommended
  • Parent management training
  • Educational intervention
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