Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a neurobiological chronic

condition characterized by developmentally inappropriate and impairing
patterns of inattention, hyperactivity, and impulsivity. The attention deficit
disorder/ hyperactivity disorder (ADHD) is the most prevalent neuropsychiatric
disorder, affecting 5-10% of children in school age, and continuing through
adolescence and adulthood in about 30-50% of them. It is the one of the most
common mental disorders affecting child.
Epidemiology
About 5% of children and about 2.5%of adults have ADHD.

Prevalence of ADHD:

1. Percentage of children 5-17 years old diagnosed 10.2%

2. Percentage of boys 5-17 years old diagnosed 14.1.
3. Percentage of girls 5-17 years old diagnosed 6.2%

• ADHD is more common in boys than girls (M:F ratio 4:1 for the
predominantly hyperactive type and 2:1for the predominantly
inattentive type.
• Inattentive subtype is more common in females.

Causes
• The exact cause and risk factor for ADHD is unknown but current
research shows that genetics plays an important role.
• Risk factor:
• Genetics: siblings with ADHD, and identical twins have greater
chances of developing ADHD
• Neurotransmitter: low levels of dopamine (causes hyperactivity
and impulsivity) and norepinephrine (causes inattention)
• Perinatal factors:
• maternal smoking
• prenatal and postnatal exposure to lead
• birth complications
• premature birth
• social factors:
• Disorganized family pattern
 • Maternal mental condition
• Alcoholism in parents
• Growing up in an institution.

Types of ADHD:
Three major types of ADHD include the following:

• Combined type ADHD: This, the most common type of ADHD, is

characterized by impulsive and hyperactive behaviors as well as
inattention and distractibility.
• Predominantly hyperactive-impulsive type ADHD: This is the least
common type of ADHD, is characterized by impulsive and
hyperactive behaviors without inattention and distractibility.
• Predominantly inattentive type ADHD: This type of ADHD is
characterized predominately by inattention and distractibility without
hyperactivity.

Sign and symptom

The symptoms of attention deficit hyperactivity disorder (ADHD) can be
categorized into 2 types of behavioral problems:

• inattentiveness (difficulty concentrating and focusing)

• hyperactivity and impulsiveness
• Many people with ADHD have problems that fall into both these
categories, but this is not always the case.
• For example, around 2 to 3 in 10 people with the condition have
problems with concentrating and focusing, but not with hyperactivity
or impulsiveness.
• This form of ADHD is also known as attention deficit disorder
(ADD). ADD can sometimes go unnoticed because the symptoms
may be less obvious.
• ADHD is more often diagnosed in boys than girls. Girls are more
likely to have symptoms of inattentiveness only, and are less likely to
show disruptive behavior that makes ADHD symptoms more obvious.
This means girls who have ADHD may not always be diagnosed.
Symptoms in children and teenagers

• The symptoms of ADHD in children and teenagers are well defined,

and they're usually noticeable before the age of 6. They occur in more
than 1 situation, such as at home and at school.
• Children may have symptoms of both inattentiveness and
hyperactivity and impulsiveness, or they may have symptoms of just 1
of these types of behavior.

Inattentiveness (difficulty concentrating and focusing)

• The main signs of inattentiveness are:

• having a short attention span and being easily distracted

• making careless mistakes – for example, in schoolwork
• appearing forgetful or losing things
• being unable to stick to tasks that are tedious or time-consuming
• appearing to be unable to listen to or carry out instructions
• constantly changing activity or task
• having difficulty organizing tasks

Hyperactivity and impulsiveness

• The main signs of hyperactivity and impulsiveness are:

• being unable to sit still, especially in calm or quiet surroundings

• constantly fidgeting
• being unable to concentrate on tasks
• excessive physical movement
• excessive talking
• being unable to wait their turn
• acting without thinking
• interrupting conversations
• little or no sense of danger
 • These symptoms can cause significant problems in a child's life, such
as underachievement at school, poor social interaction with other
children and adults, and problems with discipline.

Diagnosis

Healthcare providers use the guidelines in the American Psychiatric

Association’s Diagnostic and Statistical Manual, fifth edition (DSM-5), to
help diagnose ADHD. This diagnostic standard helps ensure that people are
appropriately diagnosed and treated for ADHD. Using the same standard
across communities can also help determine how many children have
ADHD, and how public health is impacted by this condition.

• DSM- 5 criteria for ADHD:

• People with ADHD show a persistent pattern
of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development:
• Inattention: Six or more symptoms of inattention for children up
to age 16 years, or five or more for adolescents age 17 years and
older and adults; symptoms of inattention have been present for
at least 6 months, and they are inappropriate for developmental
level:
• Often fails to give close attention to details or makes careless
mistakes in schoolwork, at work, or with other activities.
• Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (e.g., loses
focus, side-tracked).
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require
mental effort over a long period (such as schoolwork or
homework).
• Often loses things necessary for tasks and activities (e.g. school
materials, pencils, books, tools, wallets, keys, paperwork,
eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities.
• Hyperactivity and Impulsivity: Six or more symptoms of
hyperactivity-impulsivity for children up to age 16 years, or five
or more for adolescents age 17 years and older and adults;
 symptoms of hyperactivity-impulsivity have been present for at
least 6 months to an extent that is disruptive and inappropriate
for the person’s developmental level:
• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is
expected.
• Often runs about or climbs in situations where it is not
appropriate (adolescents or adults may be limited to feeling
restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go” acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been
completed.
• Often has trouble waiting their turn.
• Often interrupts or intrudes on others (e.g., butts into
conversations or games)
• In addition, the following conditions must be met:
• Several inattentive or hyperactive-impulsive symptoms were present
before age 12 years.
• Several symptoms are present in two or more settings, (such as at
home, school, or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the
quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder
(such as a mood disorder, anxiety disorder, dissociative disorder, or
personality disorder). The symptoms do not happen only during the
course of schizophrenia or another psychotic disorder.
• Based on the types of symptoms, three kinds (presentations) of
ADHD can occur:
• Combined Presentation: if enough symptoms of both criteria
inattention and hyperactivity-impulsivity were present for the past 6
months
• Predominantly Inattentive Presentation: if enough symptoms of
inattention, but not hyperactivity-impulsivity, were present for the
past six months
• Predominantly Hyperactive-Impulsive Presentation: if enough
symptoms of hyperactivity-impulsivity, but not inattention, were
present for the past six months.
• Because symptoms can change over time, the presentation may
change over time as well.
 • Diagnosing ADHD in Adults
• ADHD often lasts into adulthood. To diagnose ADHD in adults and
adolescents age 17 years or older, only 5 symptoms are needed
instead of the 6 needed for younger children. Symptoms might look
different at older ages. For example, in adults, hyperactivity may
appear as extreme restlessness or wearing others out with their
activity.

Related conditions alongside ADHD

• Anxiety disorder – which causes your child to worry and be nervous
much of the time; it may also cause physical symptoms, such as a
rapid heartbeat, sweating and dizziness
• oppositional defiant disorder (ODD) – this is defined by negative
and disruptive behavior, particularly towards authority figures, such
as parents and teachers
• conduct disorder – this often involves a tendency towards highly
antisocial behavior, such as stealing, fighting, vandalism and harming
people or animals
• depression
• sleep problems – finding it difficult to get to sleep at night, and
having irregular sleeping patterns
• autistic spectrum disorder (ASD) – this affects social interaction,
communication, interests and behavior
• dyspraxia – a condition that affects physical co-ordination
• epilepsy – a condition that affects the brain and causes repeated fits or
seizures
• Tourette's syndrome – a condition of the nervous system,
characterized by a combination of involuntary noises and movements
(tics)
• learning difficulties – such as dyslexia

Differential diagnosis
Medical conditions that can mimic ADHD include: [4]

• Learning/language problems
• Mood disorders (depression, anxiety)
• Psychiatric disorders
 • Seizure disorders
• Vision/hearing problems
• Tourette’s Syndrome
• Cognitive and behavioral disorders
• Sleep disorders
• Thyroid issues
• Substance abuse
• Brain injury

Medical management:
Stimulant medication: Several heart-related deaths have occurred in
children and teenagers taking stimulants. Although unproven at this point
as to why this is, it’ is believed that people who already have heart
disease or heart defect are at greater risk for this [5]

Class: Amphetamines

• Adderall (mixed amphetamine salts)

• Adderall XR (Extended-release mixed amphetamine salts)
• Dexedrine (Dextroamphetamine)
• Dexedrine Spansule (Dextroamphetamine)
• Vyvanse (Lisdexamfetamine (extended release))

Class: Methylphenidate

• Concerta (Methylphenidate)
• Daytrana (Methylphenidate (patch))
• Focalin (dexmethylphenidate)
• Focalin XR (extended release dexmethylphenidate)
• Metadate ER extended-release methylphenidate)
• Metadate CD (extended-release methylphenidate)
• Methylin (Methylphenidate hydrochloride)
• Quillivant XR (extended-release methylphenidate)
• Ritalin (Methylphenidate)
• Ritalin LA (extended-release methylphenidate)
• Ritalin SR (extended-release methylphenidate)
Non stimulant medication:

Concerns have been raised that there may be a slightly increased risk of
suicidal thoughts in children and teenagers taking non-stimulant
medication or antidepressants. Contact your child’s doctor if you notice
any signs of depression or suicidal thoughts.

Class: Norepinephrine Uptake Inhibitor

• Strattera (Atomoxetine)
Class: Alpha Adrenergic Agents

• Intuniv (extended-release guanfacine)

• Kapavay (extended-release clonidine)

Physiotherapy management:

Physical activity and exercise have been shown to reduce stress, anxiety,
and depressive symptoms as well as improve cognitive function. Research
exists to show that regular exercise can alter brain functions both
emotionally and cognitively.
• moderate to high-intensity exercise improved parent-teacher behavior
reports and levels of information processing as well as motor
performance
• Physical activity improves social skills and behavior as well in those
with ADHD, especially children.
• Another possible intervention for those with ADHD is yoga.
• massage therapy techniques.
• breathing exercises
• and Aquatic has been shown to reduce anxiety, stress And promote
relaxation, and improve the quality of life.
Besides research has shown that techniques like Watsu decrease the muscle
tension and pain, by affecting all physical, psychological, and emotional
levels, and also reduces stress, anxiety, and fatigue. Accordingly, Watsu is
useful for children, because it is fun, allowing facilitating the movement,
stimulating further the child to treatment.
Other treatment:
Complications for children
ADHD can make life difficult for children. Children with ADHD:

• Often struggle in the classroom, which can lead to academic

failure and judgment by other children and adults
• Tend to have more accidents and injuries of all kinds than do
children who don't have ADHD
• Tend to have poor self-esteem
• Are more likely to have trouble interacting with and being
accepted by peers and adults
• Are at increased risk of alcohol and drug abuse and other
delinquent behavior

Complications for adults

ADHD can make life difficult for you. ADHD has been linked to:

• Poor school or work performance

• Unemployment
• Financial problems
• Trouble with the law
• Alcohol or other substance misuse
• Frequent car accidents or other accidents
• Unstable relationships
• Poor physical and mental health
• Poor self-image
• Suicide attempts

Prevention

To help reduce your child's risk of ADHD:

• During pregnancy, avoid anything that could harm fetal

development. For example, don't drink alcohol, use recreational
drugs or smoke cigarettes.
 • Protect your child from exposure to pollutants and
toxins, including cigarette smoke and lead paint.
• Limit screen time. Although still unproved, it may be prudent for
children to avoid excessive exposure to TV and video games in the
first five years of life.

Lifestyle and home remedies:

Because ADHD is complex and each person with ADHD is unique, it's hard
to make recommendations that work for every child. But some of the
following suggestions may help create an environment in which your child
can succeed.

Children at home

• Show your child lots of affection

• Find ways to improve self-esteem.
• Use simple words and demonstrate when giving your child
directions.
• Identify difficult situations.
• Use timeouts or appropriate consequences for discipline.
• Work on organization.
• Try to keep a regular schedule for meals, naps and bedtime. .
• Encourage social interaction.
• Adopt healthy lifestyle habits.

Children at school

Learn all you can about ADHD and opportunities that are available to help
your child be successful. You are your child's best advocate.

• Ask about school programs.

• Talk to your child's teachers.

Lifestyle and home remedies for adults

Because ADHD is a complex disorder and each person is unique, it's hard to
make recommendations for all adults who have ADHD. But some of these
suggestions may help:
 • Make a list of tasks to accomplish each day. Prioritize the items.
Make sure you're not trying to do too much.
• Break down tasks into smaller, more manageable steps. Consider
using checklists.
• Use sticky pads to write notes to yourself. Put them on the fridge, on
the bathroom mirror, in the car or in other places where you'll see the
reminders.
• Keep an appointment book or electronic calendar to track
appointments and deadlines.
• Carry a notebook or electronic device with you so that you can
note ideas or things you'll need to remember.
• Take time to set up systems to file and organize information, both
on your electronic devices and for paper documents. Get in the habit
of using these systems consistently.
• Follow a routine that's consistent from day to day and keep items,
such as your keys and your wallet, in the same place.
• Ask for help from family members or other loved ones.
Prognosis
The symptoms of ADHD usually improve with age but many adults who
were diagnosed with the conditions at a young age continue to experience
problems. people with ADHD may also have additional problems such as
sleep and anxiety disorder. Untreated ADHD negatively affects a child’s
social and educational performance and can seriously damage his or her
sense of self-esteem.