Attention Deficit Disorders

 

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Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - James Vardeman, Nathan Smith, Kim Jackson, Shaimaa Eldib, Rucha Gadgil, Shreya Pavaskar, Uchechukwu Chukwuemeka, Vidya Acharya, Elaine Lonnemann, Eugenie Lamprecht, 127.0.0.1, WikiSysop and Simisola Ajeyalemi  

Definition/Description

According to the National Institute of Mental Health, Attention-deficit/hyperactivity disorder (ADHD) is defined as “a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”1. In adults, this disorder may cause trouble getting organized, remembering appointments, or even have trouble keeping a job. Activities of Daily Living are affected due to the inability to keep attention on one task at a time.2 Chronic condition affecting millions of children and often continues into adulthood. Children with ADHD may also struggle with low self-esteem, troubled relationships, and poor performance in school. Symptoms experienced by these individuals sometimes diminish as one ages. For those who's symptoms persists, coping strategies can be learned in order to be successful. 3

Prevalence

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Characteristics/Clinical Presentation

ADHD symptoms start before age of 12, and sometimes as noticeable as young as 3 y.o. Symptoms can range from mild to severe and can continue into adulthood. 7

In children, symptoms include:8, 10

•Excessive daydreaming

•Forgetfulness

•Squirming/fidgeting excessively

•Talking excessively

•Trouble getting along with peers

•Poor academic performance

•Trouble with organizing tasks and activities

•Easily distracted

ADHD usually presents in 3 different ways in children:8 •Predominantly Inattentive: wandering off task, difficulty sustaining focus, disorganized

•Predominantly Hyperactive-Impulsive: Hyoeractivity means a person moves constantly, or is restless; impulsivity means a person makes hasty actions that occur in the moment

•Combined

In order to be diagnosed with ADHD as an adult, several factors must be taken into account. According to the National Institute of Mental Health, four factors must be taken into consideration:9, 10

•Several symptoms must be present before the age of twelve.

•A person must have at least five symptoms of either inattention and/or hyperactivity-impulsivity.

•The symptoms must be present in two or more settings, such as at home and at work

•There must be evidence the symptoms interfere with the person’s functioning in these settings.

Symptoms of ADHD in adults include:

•Failure to pay attention to details/makes careless mistakes

•Difficulty keeping attention on tasks

•Difficulty organizing tasks and activities

•Avoids activities requiring sustained mental effort

•Easily distracted

•Forgetfulness in activities of daily living

•Fidgety/squirms

•Unable to remain still for extended periods of time

Associated Co-morbidities

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Medications

Stimulants

Class: Amphetamines12

•Adderall (mixed amphetamine salts)

•Adderall XR (Extended release mixed amphetamine salts)

•Dexedrine (Dextroamphetamine)

•Dexedrine Spansule (Dextroamphetamine)

•Vyvanse (Lisdexamfetamine (extended release))

• Several heart-related deaths have occurred in children and teenagers taking stimulants. Although unproven at this point as to why this is, it’ believed that people who already have heart disease or heart defect are at greater risk for this.13

Class: Methylphenidate12

•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-stimulants12

Class: Norepinephrine Uptake Inhibitor

•Strattera (Atomoxetine)

Class: Alpha Adrenergic Agents

•Intuniv (extended release guanfacine)

•Kapavay (extended release clonidine)

Concerns have been raised threat there may be a slightly increased risk of suicidal thoughts in children and teenagers taking nonstimulant medication or antidepressants. Contact your child’s doctor if you notice any signs of depression or suicidal thought.13

Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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