ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) Definition:
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