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Characterized by  

  • Inattentiveness
  • Impulsiveness
  • Hyperactivity  

Age of onset: Before age 7

 

DIFFERENTIAL DIAGNOSIS

  • Age-appropriate overactivity
  • Attention-Deficit Disorder (ADD)
  • Mental retardation
  • Mood disorder
  • Pervasive Developmental Disorder
  • Hearing-impairment  
  • Lead toxicity
  • Hyperthyroidism

 

CLINICAL FEATURES (DSM = Diagnostic and Statistical Manual of Mental Disorders.)*

  • Inattentiveness
  • Difficulty to carry out instructions
  • Difficulty sustaining attention 
  • Does not listen to what is being said to them
  • Loses things necessary for tasks or activities at school or at home
  • Easily distracted by extraneous stimuli
  • Impulsive
  • Difficulty awaiting turn in games or group situations  
  • Blurts out answers to questions before the question has been completed
  • Shifts from one uncompleted activity to another
  • Interrupts others
  • Engages in physically dangerous activities without considering possible consequences
  • Hyperactive
  • Fidgets with hands or feet 
  • Difficulty remaining seated or playing quietly  
  • Talks excessively

 

*Remember

  • They must have 8/14 criteria for diagnosis
  • Onset should be less than 7 years of age
  • Symptoms for longer than 6 months

 

INVESTIGATIONS:

  • Cognitive Testing
  • Achievement Wide Range Achievement Test (WRAT)  
  • Attention Conners rating scale  
  • Impulsivity Kagan’s matching familiar figure test
  • Attention and Impulsivity Paired associated learning  
  • Behaviour Rating Scales
  • Yale Child Checklist  

Imaging

  • Positron Emission Tomography (PET) -Focal hypoperfusion and diminished glucose use in the pre-motor cortex and superior prefrontal cortex 
  • CT (Head) If indicated
  • Evoked Potentials
  • Speech and Language Assessment

 

MANAGEMENT:

Non-Pharmacological  Behavioural Modification  

  • Psychotherapy  

Pharmacological   

Stimulant Medications

  • Methylphenidate (Ritalin)  
  • Dextroamphetamine (Dexedrine)
  • Methamphetamine (Desoxyn)
  • Pemoline (Cylert)   

Non-Stimulant Medications   

  • Tricyclic Antidepressants- Imipramine, Desipramine   
  • Antipsychotic Agents-    Phenothiazines, Haloperidol, Clonidine  

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