Manoj Pradeep.B, Group 3, Faculty Of Medicine, Tbilisi State Medical University.

It is the most common neurobehavioral

disorder of childhood.

One of the most prevalent chronic health

conditions affecting school-aged children

It is the most extensively studied mental

disorder of childhood

Inattention

Motor

overactivity

and motor

restlessness

Poor impulse

control and

decreased self-

inhibitory

capacity

Directly affects Dopamine Neurotransmission.

Dopamine Transporter

Gene (DAT1) Dopamine 4 Receptor Gene

(DRD4)

Additional genes that may

contribute to ADHD include

DOCK2 - involved in

cytokine regulation,

A sodium-hydrogen

exchange gene, and

DRD5, SLC6A3, DBH, SNAP25, SLC6A4, and

HTR1B.

Toxins:

Alcohol

Tobacco

Lead

Organophosphates

Abnormal brain structure and traumatic

brain injury.

Psychosocial family stressors : Increase

symptoms

Reduction in brain volume with proportional decrease in left sided pre-frontal

cortex.

Connection tracts between prefrontal cortex and striatum are also lost.

Loss Of Executive

Functions,

Personality

& Mood

*The criteria for an executive function deficit

are met in 30–50% of children and

adolescents with ADHD

Dopamine

Hypothesis:

Increased

Dopamine

Receptors

Decreased

Dopamine

TransportersAdaptive

Mechanisms

The behavior must be developmentally inappropriate.

Must begin before age 7 years, must be present for at least 6 months, must be

present in 2 or more settings.

Must not be secondary to another disorder.

3 Sub Types of ADHD

Inattentive type

Hyperactive-impulsive type

Combined type

Common in females

Common in males

Motor restlessness

Aggressive and

disruptive behavior

preschool children

Disorganized,

distractible, and

inattentive symptoms

A systematic clinical interview is mandatory for a comprehensive understanding of whether the symptoms meet the diagnostic criteria for ADHDBehavioral Rating Scale

Behavior rating scales are useful in establishing the magnitude and

pervasiveness of the symptoms, but are not sufficient alone to make a

diagnosis of ADHD.

There are a variety of well-established behavior rating scales

The Conner Rating Scale

The ADHD Index

The Swanson, Nolan, and Pelham Checklist (SNAP)

The ADD-H: Comprehensive Teacher Rating Scale (AcTERS).

The Conner Rating Scale

Teachers Rating Scale

Considering a Tox-screen in children with

suspected exposure.

Behavior in the structured laboratory setting

may not reflect the child's typical behavior in

the home or school environment. Therefore,

reliance on observed behavior in a physician's

office may result in an incorrect diagnosis.

Computerized attentional tasks and

electroencephalographic assessments are not

needed to make the diagnosis.

There are no laboratory tests available to

identify ADHD in children.

This study focused on 35 adults who were diagnosed with ADHD as children; 13 of them

still have the disorder, while the rest have recovered.

Shifting brain patterns

If it can be confirmed, this pattern could become a target for potential modification to

help patients learn to compensate for the disorder without changing their genetic

makeup.

Lingering problems

The researchers now plan to investigate how ADHD medications influence the brain's

default mode network, in hopes that this might allow them to predict which drugs will

work best for individual patients

Chronic illnesses : migraine headaches, absence seizures, asthma and allergies,

hematologic disorders, diabetes, childhood cancer affect up to 20% of children in the U.S.

and may impair children's attention and school performance.

Substance abuse : In older children and adolescents it may result in declining school

performance and inattentive behavior.

Sleep disorders : including those secondary to chronic upper airway obstruction from

enlarged tonsils and adenoids, frequently result in behavioral and emotional symptoms.

Behavioral and emotional disorders may cause disrupted sleep patterns.

Depression and anxiety : may cause many of the same symptoms as ADHD (inattention,

restlessness, inability to focus and concentrate on work, poor organization, forgetfulness),

but may also be comorbid conditions.

Although ADHD is believed to be due to primary impairment of attention, impulse

control, and motor activity, there is also a high prevalence of comorbidity with other

psychiatric disorders.

The parents and child should be educated with regard to the ways in which ADHD can affect learning,

behavior, self-esteem, social skills, and family function.

Goals must be set for the family to improve the child's interpersonal relationships, develop study skills,

and decrease disruptive behaviors.

Such treatments occur in the time frame of 8–12 sessions.

The goal of such treatment is for the clinician to identify targeted behaviors that cause

impairment in the child's life and for the child to work on progressively improving his

or her skill in these areas.

The clinician should guide the parents and teachers in implementing rules,

consequences, and rewards to encourage desired behaviors.

METHYLPHENIDATE :

Mechanism – Unclear.

Methylphenidate is a norepinephrine and dopamine reuptake inhibitor DAT4 inh.

DEXMETHYLPHENIDATE

Increases catecholaminergic neurotransmission by inhibiting the dopamine transporter (DAT)

and norepinephrine transporter (NET) particularly in the striatum and meso-limbic system

DEXTROAMPHETAMINE

Activation of TAAR1 increases cAMP production via adenylyl cyclase activation and inhibits the

function of the dopamine transporter, norepinephrine transporter, and serotonin transporter, as

well as inducing the release of these monoamine neurotransmitters

TRICYCLIC ANTIDEPRESSANTS

Are currently being replaced by SSRI’s and SNRI’s

by blocking the serotonin transporter (SERT) and the norepinephrine transporter(NET)

Selective Nor-epinephrine Reuptake Inhibitors [NRI’s]

Alpha Agonists:

Clonidine: Presynaptic Alpha-2 Blockers.

A childhood diagnosis of ADHD often leads to persistent ADHD throughout the life span.

From 60–80% of children diagnosed with ADHD continue to experience symptoms in

adolescence, and up to 40–60% of adolescents exhibit ADHD symptoms into adulthood.

In children diagnosed with ADHD, a reduction in hyperactive behavior often occurs with

age. However, other symptoms associated with ADHD can become more prominent with

age, such as inattention, impulsivity, and disorganization, and these exact a heavy toll on

young adult functioning.

A variety of risk factors can affect children with untreated ADHD as they become adults.

These risk factors include engaging in risk-taking behaviors (sexual activity, delinquent

behaviors, substance use), educational underachievement or employment difficulties, and

relationship difficulties. With proper treatment, the risks associated with the disorder

can be significantly reduced.

Literature:

• Natoshia Raishevich Peter Jensen : Nelson’s Textbook Of Pediatrics 8th Edition

• Parthasarathy A : IAP Textbook Of Pediatrics 4th Edition

Online References:

Aaron T. Mattfeld, John D.e. Gabrieli, Joseph Biederman, Thomas Spencer, Ariel Brown,

Amelia Kotte, Elana Kagan, and Susan Whitfield-Gabrieli. Brain differences between

persistent and remitted attention deficit hyperactivity disorder. Brain, June 2014

DOI: 10.1093/brain/awu137

Brookhaven National Laboratory: http://www.bnl.gov/newsroom/news.php?a=1565

Center of Disease Control : http://www.cdc.gov/ncbddd/adhd/

WebMD: http://www.webmd.com/add-adhd/default.htm?names-dropdown

National Institute of Mental Health : http://www.nimh.nih.gov/health/topics/attention-deficit-

hyperactivity-disorder-adhd/index.shtml

Wikipedia : http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder

http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders