Attention Deficit/Hyperactivity Disorder Disease

BASICS

DESCRIPTION

A behavior problem characterized by a short attention span, low frustration tolerance, impulsivity, distractibility, and usually, hyperactivity. This can result in poor school performance, difficulty in peer relationships, and parent/child conflict.

System(s) affected: Nervous
Genetics: Familial pattern
Incidence/Prevalence in USA: 5% of school aged children
Predominant age:
- Onset < 7 years old
- Lasts into adolescence and adulthood
- 50% meet diagnostic criteria by age 4
Predominant sex: Males > Females (5:1)

SIGNS AND SYMPTOMS

DSM-IV Criteria - 6 or more inattention criteria and/or 6 or more hyperactivity/impulsivity criteria

Inattention
- Careless mistakes in tasks
- Difficulty sustaining attention
- Doesn't seem to listen
- Doesn't follow through or finish
- Difficulty organizing tasks
- Avoids tasks which require sustained mental effort
- Loses things
- Easily distracted
- Forgetful
Hyperactivity/impulsivity
- Fidgets
- Difficulty remaining seated
- Runs or climbs excessively
- Difficulty playing quietly
- Acts as if "driven by a motor"
- Talks excessively
- Blurts out answers before question is complete
- Has difficulty awaiting turn
- Interrupts others

CAUSES

Multifactorial

RISK FACTORS

Family history
Co-morbid conditions (associated with, but not caused by)
- Learning disabilities
- Tourette's
- Mood disorders
- Oppositional defiant disorder
- Conduct disorder

DIAGNOSIS

LABORATORY

Rarely needed, can check lead level

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

"Soft" neurological signs - nonspecific (Romberg, mixed hand preference, etc.)
Motor tics can be present (cough, noise, scratching)

SPECIAL TESTS

Learning disability evaluation (mismatch of IQ and achievement) - usually by school
Behavior rating scales to be completed by parents and teachers. Often repeated after therapy is started to gauge differences (e.g., Conner's scale, AcTERs scale).
Good psychosocial evaluation of home environment
Continuous Performance Tests - rapid fire computer test - high false negative
See References

IMAGING

Not needed

DIAGNOSTIC PROCEDURES

Diagnosis is by DSM-IV criteria. (Do not need EEG unless symptoms highly suggestive of seizure disorder [e.g., absence seizures]).

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Parent/school/patient education
Work closely with teacher
Avoid unproved therapies

SURGICAL MEASURES

N/A

ACTIVITY

Allow for increased activity in safe environment
Often respond well to water play/bathtubs

DIET

No dietary changes have been proven to help ADHD. Parents can experiment with non-harmful diets by eliminating:

Sugar
Dyes
Additives

PATIENT EDUCATION

Key points for parents:
- Strong emphasis on behavior therapy such as token systems
- Reinforce good behavior (with rewards and attention)
- Make eye contact with each request
- One task at a time
- Time out (brief) for problems
- Stop behavior before it escalates
- Find things child is good at and emphasize these
- Some families benefit from "anger training," "social training" and family therapy
- Educate parents to realistic expectations
- Awareness of child advocate groups and support groups
- Help to deal with negative feelings
Key points for teachers:
- Short work sessions
- Clear rules
- Immediate consequences
- Reinforce good behavior
- Coordinate homework with parent with daily assignment notebook
- Have second set of books at home
Support groups
- CHADD - Children and Adults with ADD, 499 NW 70th Ave, Suite 101, Plantation, FL 33317; 800-233-4050
- ADD Warehouse 300 NW 70th Ave, Suite 102, Plantation, FL 33317; 800-233-9273
- AD-IN - ADD Information Network, 475 Hillside Ave, Needham, MA 02174; 781-455-9895
- LDA - Learning Disabilities Association, 4156 Library Rd, Pittsburgh, PA 15234

FOLLOW UP

PREVENTION/AVOIDANCE

Children are at risk for: abuse, depression, social isolation
Parents need regular support and advice
Establish contact with teacher each school year

POSSIBLE COMPLICATIONS

Medications can cause headaches, abdominal pain (take with meals), growth delay
Untreated ADHD can lead to: failing school, parental abuse, social isolation, poor self esteem
If appetite poor, offer food early am and late

EXPECTED COURSE AND PROGNOSIS

May last through school years and into adulthood (25%)
It becomes easier to control with increasing age
Encourage career choices which allow patient autonomy and mobility
No increased incidence of delinquency unless other co-morbid features exist (e.g., conduct disorder)

MISCELLANEOUS

ASSOCIATED CONDITIONS

See Risk Factors

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

Avoid stimulant medications in pregnancy

OTHER NOTES

N/A

ABBREVIATIONS

ADD = Attention Deficit Disorder
LFT = liver function test

Clinical Investigations

ROLE OF HOMOEOPATHY

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