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Definition: Attention Deficit Hyperactivity Disorder (ADHD) is defined as a brain disorder associated with spontaneous uncontrollable behavior and hyperactivity. It is also known as Attention Deficit Disorder or Childhood Hyperkinesis.
Etiology or Cause: ADHA is often genetic and may be passed from parents to offsprings and other family members. The brains of children with ADHD show biochemical abnormalities in the way in which neurotransmitters particularly dopamine, serotonin, and adrenaline function.
Other Causative Factors: * Head injury * Infection of the brain and spinal cord * Premature birth * Exposure to tobacco, alcohol or other drugs while in the womb * Heavy metal poisoning e.g. lead, mercury
Consequences of ADHD: * Disruption of interpersonal relationships * Disruption of school performance * Depression * Sleep deprivation * Learning disabilities * Behavioural disabilities * Social withdrawal * Low self esteem * Deviant behavior * Burden on health care facilities * Burden on health care providers
Incidence of ADHD: ADHD is the commonest diagnosed childhood behavior. It affects 4.4 million children between the ages 4 to 17 years. ADHD is more common in male children than in female children. It normally appears in childhood and may affect all areas of a child\’s life creating tremendous burden on family, healthcare providers and health care facilities.
Symptoms of ADHD: * Documented in the Diagnostic and Statistical Manual (DSM-IV) * DSM-IV classifies ADHD symptoms into inattentiveness and hyperactivity * Symptoms must appear at least six months usually occurring before the age of 7 * The child should have at least 6 attention symptoms or 6 activity symptoms * Symptoms must be observed in two or more settings * All other problems must be eliminated * Some symptoms must appear before the age of seven * Inattention symptoms: ? Makes careless mistakes in schoolwork ? Difficulty concentrating when performing tasks ? Difficulty in interpreting verbal, auditory and written instructions ? Difficulty in organizing tasks and activities ? Avoids sustained mental activities ? Misplaces items ? Forgetful disposition ? Easily distracted * Hyperactivity symptoms: ? Energetically performs actions ? Obsessed and easily distracted with hands or feet ? Unable to sit for long periods ? Runs and climbs in inappropriate situations ? Unable to play quietly ? Talks excessively ? Difficulty awaiting turn and often intrudes on others
ADHD Diagnosis: The American Academy of Pediatrics guidelines on signs and symptoms of ADHD. ? Evaluation questionnaires ? Psychological evaluation including IQ testing and Psychological testing of child and family ? Complete developmental, mental, nutritional, physical and psychosocial examination
Treatment of ADHD: * Specific target goals must be established to guide effective therapy * Medication should be initiated on the advice of a physician. Several different types of medication may be used to treat ADHD. Methylphenidate such as Ritalin, Concerta and others and forms of amphetamine such as Dexedrine, Adderall and others may be safe and effective for most children. However, there may be some adverse side effects such as decreased appetite, weight loss, stomachaches, sleep problems, headaches and jitteriness. More serious side effects include dizziness, suttering or increased blood pressure. Recently, atomoxetine was approved for treating ADHD and is now used in treatment regimes. * Behavior therapy should be initiated together with medication or used alone to achieve positive reinforcement and incentives for consolidation of right purposeful actions * Re-evaluation of target goals to ensure therapy is effective * Perform follow-up analysis to access the effectiveness of therapy and re-evaluation of goals * Alternative treatments include the use of herbs, supplements and chiropractic manipulation. However, the effectiveness of these treatments are questionable and controversial. * Reduce distractions in the child\’s environment * Provide individual instruction when teaching * Provide a balanced diet with plenty of fruits, vegetables and fiber * Ensure that the child gets sufficient rest and relaxation
Prognosis: ADHD is a chronic disease condition that may continue to manifest in adulthood with increased incidence of juvenile delinquency and adult deviant behavior. Corrective actions and the effectiveness of these actions are dependent on early diagnosis and the application of the right mix of behavioral and drug therapy.
Prevention: At present there exists no effective method of preventing ADHD. Early diagnosis coupled with effective drugs and behavioral therapy can reduce the burden of this disease and make it more manageable.
References: American Academy of Pediatrics. Clinical Practice Guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics 2000: 105(5): 1158-1170. Pattron, D. Recent Research in Public Health. 2004. New York: Scientific Publishers.
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