Attention deficit hyperactivity disorder

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Attention deficit hyperactivity disorder
ICD-10 ICD10 F84.0-F84.1
ICD-9 314.00

, 314.01

OMIM 143465
MedlinePlus 001551

Attention deficit hyperactivity disorder (ADHD) is a "behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. Although most individuals have symptoms of both inattention and hyperactivity-impulsivity, one or the other pattern may be predominant. The disorder is more frequent in males than females. Onset is in childhood. Symptoms often attenuate during late adolescence although a minority experience the full complement of symptoms into mid-adulthood."[1][2][3]

ADHD occurs in adults also.[4]

There are significant adverse socioeconomic outcomes from ADHD.[5][6]

Etiology/cause

Twin studies suggest 76% of ADHD is inherited.[7] Abnormalities of biogenic amine receptors may contribute to ADHD.[7]

The relationship between childhood bipolar disorder and attention deficit hyperactivity disorder is uncertain.[8]

Treatment

The Multimodal Treatment Study of Children with ADHD randomized controlled trial concluded "for ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes."[9] The components of this trial included over 14 months:[10]

  • Medications: "Were seen monthly for one-half hour at each medication visit. During the treatment visits, the prescribing physician spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child’s ADHD-related difficulties. The physicians, in addition, sought input from the teachers on a monthly basis."
  • Behavior: "Families met up to 35 times with a behavior therapist, mostly in group sessions. These therapists also made repeated visits to schools to consult with children’s teachers and to supervise a special aide assigned to each child in the group. In addition, children attended a special 8-week summer treatment program where they worked on academic, social, and sports skills, and where intensive behavioral therapy was delivered to assist children in improving their behavior"

Medications

Several stimulant medications are effective.[11] Stimulants work by blocking the dopamine transporter.[2] However, these drugs may increase cardiac complications.[12]

Behavior therapy

In the United States, federal regulation provides for support to public schools for the education of children with disabilities such as attention deficit hyperactivity disorder.[13][14] Various behavioral programs have been studied.[15]

Behavioral therapy for adolescents
American Academy of Family Physicians Attention Deficit Disorder Association National Resource Center (NRC) on AD/HD

link to more details

link to more details

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  1. Make a schedule.
  2. Make simple house rules.
  3. Make sure your directions are understood.
  4. Reward good behavior.
  5. Make sure your child is supervised all the time.
  6. Watch your child around his or her friends.
  7. Set a homework routine.
  8. Focus on effort, not grades.
  9. Talk with your child's teachers
  1. Facilitate appropriate independence seeking.
  2. Maintain adequate structure and supervision.
  3. Establish “the bottom line” rules for living in your home and enforce them consistently.
  4. Negotiate with your adolescent all the other issues which are not bottom lines.
  5. Use consequences wisely.
  6. Maintain good communication.
  7. Keep a disability perspective, and practice forgiveness
  8. Focus on the positive.
  1. Establishing house rules and structure
  2. Learning to praise appropriate behaviors (praising good behavior at least five times as often as bad behavior is criticized) and ignoring mild inappropriate behaviors (choosing your battles)
  3. Using appropriate commands
  4. Using "when-then?" contingencies (withdrawing rewards or privileges in response to inappropriate behavior)
  5. Planning ahead and working with children in public places
  6. Time out from positive reinforcement (using time outs as a consequence for inappropriate behavior)
  7. Daily charts and point/token systems with rewards and consequences
  8. School-home note system for rewarding behavior at school and tracking homework

References

  1. ↑ Anonymous (2024), Attention deficit hyperactivity disorder (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 Biederman J, Faraone SV (2005). "Attention-deficit hyperactivity disorder". Lancet 366 (9481): 237–48. DOI:10.1016/S0140-6736(05)66915-2. PMID 16023516. Research Blogging.
  3. ↑ Rappley MD (2005). "Clinical practice. Attention deficit-hyperactivity disorder". N. Engl. J. Med. 352 (2): 165–73. DOI:10.1056/NEJMcp032387. PMID 15647579. Research Blogging.
  4. ↑ Okie S (2006). "ADHD in adults". N. Engl. J. Med. 354 (25): 2637–41. DOI:10.1056/NEJMp068113. PMID 16790695. Research Blogging.
  5. ↑ Biederman J, Faraone SV (2006). "The effects of attention-deficit/hyperactivity disorder on employment and household income". MedGenMed 8 (3): 12. PMID 17406154. [e]
  6. ↑ Mannuzza S, Klein RG, Bessler A, Malloy P, Hynes ME (1997). "Educational and occupational outcome of hyperactive boys grown up". J Am Acad Child Adolesc Psychiatry 36 (9): 1222–7. PMID 9291723. [e]
  7. ↑ 7.0 7.1 Faraone SV, Perlis RH, Doyle AE, et al (2005). "Molecular genetics of attention-deficit/hyperactivity disorder". Biol. Psychiatry 57 (11): 1313–23. DOI:10.1016/j.biopsych.2004.11.024. PMID 15950004. Research Blogging.
  8. ↑ Kuehn BM (March 2007). "Scientists probe child bipolar disorder". JAMA : the journal of the American Medical Association 297 (11): 1181. DOI:10.1001/jama.297.11.1181. PMID 17374805. Research Blogging.
  9. ↑ (December 1999) "A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD". Archives of general psychiatry 56 (12): 1073–86. PMID 10591283. [e]
  10. ↑ Anonymous. Attention Deficit Hyperactivity Disorder. National Institutes of Health.
  11. ↑ Pritchard D (2006). "Attention deficit hyperactivity disorder in children". Clin Evid (15): 331–44. PMID 16973014. [e]
  12. ↑ Nissen SE (2006). "ADHD drugs and cardiovascular risk". N. Engl. J. Med. 354 (14): 1445–8. DOI:10.1056/NEJMp068049. PMID 16549404. Research Blogging.
  13. ↑ Anonymous (Oct. 30, 2007). Title 34: Education: PART 300—ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES. Electronic Code of Federal Regulations.
  14. ↑ Anonymous. IDEA - Building The Legacy of IDEA 2004. U.S. Department of Education.
  15. ↑ Barkley RA, Guevremont DC, Anastopoulos AD, Fletcher KE (June 1992). "A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder". Journal of consulting and clinical psychology 60 (3): 450–62. PMID 1619099. [e]
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