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 yrC. Impairment are present in > 2 settingD. Clinically significant impairment in social,

academic or accupationalE. Doesn’t 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 doesn’t seem to listen• Often doesn’t 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