Attention deficit hyperactivity disorder

Volume 3 Issue 8 August, 2013

Attention-deficit/hyperactivity disorder (ADHD) is a condition that affects 4-5% of children while some studies show 10-12% and often it persists into adulthood in one third of them. Male to female ratio is about 2:1. ADHD includes a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

Neurobiology:
The most consistent structural brain imaging findings in children with ADHD have been significantly smaller volumes in the dorsolateral prefrontal cortex, caudate, pallidum, corpus callosum and cerebellum. Delayed myelination, disruptions in white matter microstructure and insufficient astrocyte functioning play a role in ADHD.

Diagnostic criteria:
ICD-10 and DSM-IV TR have diagnostic criteria for ADHD. Six of the nine inattentive symptoms are required for diagnosis of inattentive type and six of the hyperactive-impulsive for diagnosis of hyperactive/impulsive type, with six of each list for combined type. Comorbidities exist along with ADHD.

Signs and symptoms: Difficulty paying attention, Difficulty following instructions, Problems in organizing tasks, Forgetful and loses items, Fails to finish schoolwork, Easily distracted, Frequently fidgets, Difficulty remaining seated, Excessively impulsive, Interrupts on others, Trouble waiting for his or her turn
Psychopharmacology: Currently, stimulant drugs are the most commonly prescribed medications for ADHD. These medications help improve the signs and symptoms of inattention and hyperactivity. Examples include methylphenidate, dextroamphetamine , dextroamphetamine-amphetamine and lisdexamfetamine. Other medications used to treat ADHD include atomoxetine and antidepressants such as bupropion and desipramine. Clonidine and guanfacine have also been shown to be effective.
Psychological therapies: Behavior therapy: It is useful for children especially use of rewards, star charts, limit setting, time outs, etc Psychotherapy: This allows older children with ADHD to explore negative behavioral patterns and learn ways to deal with their symptoms. Parenting skills training: This can help parents develop ways to understand and guide their child’s behavior. Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD. Social skills training. This can help children learn appropriate social behaviors. School liaison services: The teachers can be involved in behavioral therapy programs in liaison with school counselor services in the school.
Conclusion: The best results occur when a team approach is used with teachers, parents, and Psychiatrist working together for the overall management of ADHD.