Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is characterized by persistent inattention, hyperactivity and/or impulsivity that is inconsitent with the patient’s developmental age and results in difficulty functioning in at least two settings (at home, school or work). At least 6 innatentive and/or hyperactive/impulsive symptoms are required. 5 symptoms are required for adolescents and adults age 17 years or older. Sympotms must be present for at least 6 months and the symptoms mus have been present before 12 years of age. The course is usually stable through adolescence, though many continue to have symptoms well into adulthood (inattentive > hyperactivity).
Prevalent in 5% of children and 2.5% of adults. Affects men more than women (2:1 ratio). Women present more often with inattentive symptoms
Signs and symptoms
| Inattention | Hyperactivity |
|---|---|
| Difficult close attention to detail | Restlessness |
| Difficulty in focusing | Often standing in situations where they should be seated |
| Seems not to listen when talked to | Often running or climbing |
| Often does not follow through on instructions | Noisy playing often on the go |
| Difficulty in activity | Frequently engages in excessive talking |
| Forgetfullness | Blurting answers |
| Easily distracted | Difficulty waiting or taking tunrs |
| Loses things | Talks excessively |
| Avoids or dislikes taks requiring a lot of thinking | iNTERRUPTS OR INTRUDES UPON OTHERS |
| Has difficulty with focusing |
- Causes
- Genetic: increased incidence in first-degree relatives of patients with ADHD
- Low birth weight
- Smoking during preganncy
- CHildhood abuse/neglect
- Neurotoxin/alcohol exposure
- Associations
- Oppositional defiant disorder
- Conduct disorder
- Specific Learning disorder
- Differentials
- Age-appropriate behavior: ADHD must result in difficulty funcitoning in at least two settings
- Oppositional defiant disorder: may be comorbid, but it is a more significant diagnosis and will include prominent defiancy towards figures of authority (acting out)
- Mood disorder: especially major depressive disorder. Inattention is a mood symptom.
- Treatment
- Methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexardrine), and amphetamine salts (Adderal): first-line treatment is stimulants. The theory is that individuals with ADHD have a deficiency in dopamine leading to engagement in self-stimulating behaviors. By increasing dopamine using stimulants patients will not need to engae in self-stimulating behaviors and thus will sustain focus
- Atomoxetine (norepinephrine reuptake inhibitor): second-line
- Clonidine and guanfacine: can be used in place of or as adjuncts to stimulants
- Behavior modification techniques and social skills training
- Ensure structure and reliability in home and school settings
- Family therapy
- Parent psychoeducation
