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, Uchechukwu Chukwuemeka, Vidya Acharya, Shreya Pavaskar, Elaine Lonnemann, WikiSysop, Simisola Ajeyalemi, Eugenie Lamprecht and 127.0.0.1  

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

The exact cause of ADHD is not clear but research continues on the topic. Possible factors that are thought to play a role include:7

-Genetics: ADHD can run in families, and studies show that genes may play a role.

-Environment: Factors, such as lead exposure may increase the risk

-Development: Problems with the central nervous system at key moments of development may play a role.

Risk factors for ADHD may include:

-Blood relatives with ADHD or other mental health disorders

-Maternal drug use such as alcohol or smoking during pregnancy.

-Premature birth.

-Sugar is a suspect in causing hyperactivity, but there is no reliable proof that this directly causes ADHD. Although it may play a role in one’s sustain attention, it is not considered to be a cause of ADHD.

Systemic Involvement

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Medical Management (current best evidence)

Treatment varies with age of the individuals with ADHD. For children 4 to 5 years old, treatment consists of parent and/or teacher administered behavior therapy. If the symptoms have a well founded manifestation, the doctor may prescribe medication, although this is not the most desirable course of action. Initially, attempting behavioral therapy can give the parents skills and strategies to help their child, relatively no side effects in comparison to medication presrcription, and the long term effects of ADHD medication on young children have not been widely studied. ADHD medications can cause sleeping problems, decreased appetite, delayed growth, headaches/stomachaches, rebound irritability, tics, and moodiness/irritability. 17

For children who are 6-11 years of age, then the physician should prescribe medication (usually stimulant medications), along with possible parent and/or teacher behavioral therapy. The medication is more important here, although the behavioral therapy is an important part of management as well.

For the adolescents who are defined as 12-18 yrs old, medication is the primary method of management. It is also recommended that behavior therapy is also prescribed.17

Stimulant medications are highly effective for reducing ADHD symptoms. Other medications including selective norepinephrine-reuptake inhibitors and selective alpha-adrenergic agonists have also been shown to be effective.17

Behavior therapy is a broad, non-specific intervention. Its goal is to modify both the physical and social environment to change the behaviors of those with ADHD. This is done by using rewards and consequences for certain behaviors. 17

Physical Therapy Management (current best evidence)

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Differential Diagnosis

Medical conditions that can mimic ADHD include:22

-learning/language problems

-Mood disorders (depression, anxiety)

-psychiatric disorders

-seizure disorders

-vision/hearing problems

-Tourette’s Syndrome

-cognitive and behavioral disorders

-sleep disorders

-thyroid issues

-substance abuse

-Brain injury

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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