ADHD: A Very Common Disorder!

Attention Deficit Hyperactivity Disorder (ADHD) is a very common disorder that manifests in childhood. It is characterized by hyperactivity, impulsivity, and/or inattention symptoms. This disorder affects cognitive, behavioral, emotional, and academic functioning and can persist into adolescence and adult life.

Epidemiology

• Affects 6-10% of school-aged children
• 3-5 times more common in males than females
• Different rates between different countries (Under diagnosis, lack of appropriate educational systems, etc.)
• Represents 25% of paediatric- psychiatric consultations
• Affects 2-6% of adolescents
• Affects 2% of adults

 Risk Factors

The pathogenesis of ADHD is not  yet clearly understood, but some factors were described in several studies :

• Genetic factors (Dopamine receptors)
• Neuroanatomical factors
• Prenatal exposure to tobacco smoke / Alcohol
• Prematurity
• Dietary influences (Food additives, colorants etc.)

Symptoms

1. A)Inattention:

• Fails to give close attention to details
• Makes careless mistakes in schoolwork or other activities
• Finds  difficulty in sustaining attention to tasks or play activities
• Does not seem to listen to what is being said
•  Does not follow instructions
• Finds  difficulty  in tasks and activities’ organization
• Loses necessary things (pencils, toys etc.)
•   Is easily distracted by extraneous stimuli

1. B)Hyperactivity / Impulsivity:

Impulsivity is divided into verbal impulsivity (answering before the questions are completed) and behavioral impulsivity (acting without thinking). Moreover, ADHD patients are not aggressive children.

In fact, the disease can lead to violent acts as a complication of missed diagnosis or lack of treatment, but not as a manifestation of the disorder itself

•  Tapping hands or feet, squirming in seat
• Leaving seat in classroom
• Climbing excessively in inappropriate situations
• Difficulty playing quietly
• Inability to be still for extended periods of time
• Excessive talking
• Answering before the questions have been completed
• Difficulty waiting in lines or awaiting turn
• Interrupting others

Diagnostic Criteria

Hyperactivity can result from many causes  other than ADHD (Stress, anxiety, learning disabilities, addiction etc.),  so a specific diagnostic procedure is recommended to diagnose ADHD:

• More than 6 symptoms of hyperactivity/impulsivity or inattention
• Symptoms  persisting for  more than 6 months
• Symptoms presenting before the age of 5 years
• Persistence of symptoms in more than one setting (e.g. school and home)
• Impaired functioning in academic, social, or occupational activities

 Subtypes

ADHD subtypes depend on the predominant symptom. ADHD can be categorized into one of these three subtypes:

•  Predominantly inattentive (25%, mainly in females)
•  Predominantly hyperactive/impulsive (25%)
•  Combined (50%)

 Complications and Co-morbidities

1. a)Oppositional defiant disorder:

• Loss of  temper, disputes, blaming  others for one’s own mistakes and refusing to comply with rules

1. b)Depression:

• Problems concentrating / Loss of motivation
• Feeling sad, hopeless
• Suicidal thoughts

1. c)Conduct disorder:

• Impulsiveness
• No regard to consequences

1. d)Anxiety:

• Persistent intense fear and/or worry

1. e)Low self-esteem

 Impact of untreated and under-treated ADHD

• Higher risk of ER VISITS/Accidents
• Parental divorce
• Sibling fights
• High risk of substance use disorders
• Lower occupational status
• Decreased productivity

Management

• Psychotherapeutic  interventions
• School-based interventions
• Environmental changes
• Behavioural therapy
• Familial support
• Pharmacotherapy: Psychostimulants: Methylphenidate (Ritaline / Concerta / Atomoxetine (Strattera))

References:

1- MED2 MDG595 , DR. SOUFIA

2- MED2 MDG600 DR.SOUAIBY 

3- Uptodate

4- Medscape