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Attention-Deficit/ Hyperactivity Disorder: Hicham Baba - Med3 Psychiatry Clerkship

ADHD is a common neurobehavioral disorder in children characterized by inattention, hyperactivity, and impulsiveness. It affects 5-9% of school-aged children. The exact causes are unknown but there is a strong genetic component and structural differences in brain regions involved in attention and motor control. Diagnosis involves ruling out other conditions and using behavior rating scales from multiple observers. Treatment involves behavioral therapy and may include stimulant medications.

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Ali B. Safadi
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88 views

Attention-Deficit/ Hyperactivity Disorder: Hicham Baba - Med3 Psychiatry Clerkship

ADHD is a common neurobehavioral disorder in children characterized by inattention, hyperactivity, and impulsiveness. It affects 5-9% of school-aged children. The exact causes are unknown but there is a strong genetic component and structural differences in brain regions involved in attention and motor control. Diagnosis involves ruling out other conditions and using behavior rating scales from multiple observers. Treatment involves behavioral therapy and may include stimulant medications.

Uploaded by

Ali B. Safadi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Attention-Deficit/

Hyperactivity Disorder

Hicham Baba - Med3


Psychiatry Clerkship
ADHD: Definition

 Most common
neurobehavioral disorder
in children
 It is characterized by:
1. Inattention
2. Hyperactivity
 Inappropriate excessive
motor activity
3. Impulsiveness
 Hasty, without forethought
Harmful to self

 Subtypes
 Predominantly inattentive
 Predominantly hyperactive/impulsive
 Combined type
Epidemiology
 Prevalence:

 5-9% of school-age children
 2-6% of adolescents
 2.5% of adults
 2:1 male-female ratio.
 Females present with ADD
 Several symptoms present before age 12
 Symptoms occur in at least 2 settings

 The incidence of ADHD appears increased in children with


neurologic disorders such as epilepsies, neurofibromatosis,
tuberous sclerosis.
Relevance

Children often have a bad
experience with:
 School
 Academic problems
 Relationship issues
 Family
 Self-esteem
 Future likelihood of conduct and antisocial disorders
Risk Factors

 Maternal drug use
 Alcohol use
 Lead and mercury exposure
 Birth complications, such as
toxemia, lengthy labor, and
complicated delivery.
 Very low birth weight
Etiology

 There is a very strong genetic component to ADHD.
 Genetics: DAT1 and DRD4 dopamine genes
 Structural:
 atrophied prefrontal cortex and basal ganglia (~10%)
 low blood flow to the striatum
 These areas are rich in dopamine

 20% of children with severe traumatic brain injury are


reported to have subsequent onset of substantial symptoms
of impulsivity and inattention.
Symptoms

Symptoms >6
predominantly inattentive <-> combined <-> predominantly hyperactive/impulsive


Diagnosis of ADHD

 Careful history and clinical interview
 Completion of behavior rating scales by different observers
from at least 2 settings (teacher and parent);
 A physical examination; and any necessary or indicated
laboratory tests which arise from conditions suspected based on
history and/or physical examination
 No specific test to diagnose
 FDA has approved the Neuropsychiatric EEG-Based
Assessment Aide (NEBA) system, which may identify an
abnormal theta : beta wave ratio associated with ADHD.
Behavior Rating Scales

Differential Diagnosis

 Absence seizures  Disruptive mood
 Migraine dysregulation
 Asthma and allergies,  Depression and bipolar
 Hematologic disorders  Autism
 Diabetes, cancer  Tourette
 Substance abuse  Specific learning
 Sleep disorders  Intellectual disability
 Restless leg syndrome  Personality (borderline,
 Oppositional defiant narcissistic…)
 Intermittent explosive  OCD
 Adjustment
Associated Disorders

 Of children with ADHD:
 15-25% have learning disabilities,
 30-35% have developmental language disorders,
 15-20% have diagnosed mood disorders,
 20-25% have coexisting anxiety disorders.

 Children with ADHD can also have co-occurring diagnoses


of sleep disorders, memory impairment, and decreased motor
skills.
ADHD and adulthood

TREATMENT

Age Therapy
4-5 years Behavioral mainly
6-11 years Behavioral + Pharma
12-18 years Pharma mainly
TREATMENT

1- Behavioral Therapy
Initial therapy when:
 Symptoms are mild with minimal impairment
 Diagnosis is not certain, or disagreement parent/teacher
 Parents reject medication treatment
Outcomes:
 Improve behavior, control and self-esteem
 Most effective when given by parents (w/ doctor support)
TREATMENT

2- Pharmacological Therapy
Stimulants
 Dextroamphetamine (DEX)
 Methylphenidate (Ritaline) (don’t use <6yo)
 Mixed salts amphetamine,

Most common side effects of stimulants is weight loss and decreased appetite

Non-stimulants
 Atomoxetine (co-substance/anxiety/tics)
 Alpha-2 agonists (clonidine, guanfacine)
ADHD - Summary


References

 DSM V
 Kaplan and Saddock
 Uworld
 Google.images.com
 Dr. Tahan’s lecture during Med2

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