ADHD and its treatment
I. INTRODUCTION
- Most Common behavioral condition in children(8%, 3-9 times more in boys)
- Diagnosed by DSM-IV as three main types: Predominately inattentive, Predominately hyperactive, or combined.
- ADHD continues into adulthood and carries high risk of learning differences, and problems with behavioral, emotional, and social functioning.
II. CAUSES
- Neurological
- Most children have no gross structural damage to the central nervous system
- While Neuro – imaging studies show no difference with normal children
research indicated that some brain regions may have decreased activity in people with the disorder.
2. Biochemical
- Low levels of neurotransmitters that are responsible for focus. (epinephrine, norepinephrine, and dopamine)
- Conventional medication restore the balance in the brain.
- Currently there is no available biological marker for the diagnosis of ADHD
3. Genetic
- Numerous studies show evidence of genetic association.(5-6 times increases with an affected relative)
- No single gene has been associated rather multiple genes that regulate brain receptors and neurotransmitters.
- Multiple complex interactions between multiple genes and environments
- Dietary and environmental factors unproven. Excessive carbohydrates can have a negative effect in learning in certain children but still unclear. (smoking)
- Certain proteins are essential for neurotransmitters. Only one individual will have the deficiency.
4. Electronic media
- Over stimulation of brain with early television may cause attention problems later.
- ADHD is a risk factor for internet addiction and gaining.
III. Diagnosis
1. must meet criteria and rule out alternative/ medical causes of similar symptoms.
- Must rule out conditions(table1) that co-exist like anxiety, defiance, learning a language disorder and physical. Full physical and medical evaluation as well as neuropsychological evaluation.
- DSM-IV criteria table 2 . inattention, hyperactivity, and impulsivity associated with problems remaining focused in a task for prolonged period , organizational problems, prioritizing, and time management.
- Same prevalence in all countries, social rather than ethnical.
- Mainly clinical (questionnaires and rating scale but unreliable)
- Age inappropriate levels of motor hyperactivity and inattention.
- Sleep disorders such as sleep initiation problems, maintaining sleep problems and awakening problems.(60%)
- Hyperactivity during sleep. Restless leg syndrome (40%)
2. Controversy of diagnosis
- Unstructured criterias that are different in DSM-IV vs international classification
- Children who exhibit symptoms of ADHD but no functional impairment do not meet the criteria (subjective)
- Commonly associated with other physiological, psychiatric and developmental disorders that overlap with ADHD.
IV. Long term social abuse
- Problems persist in adulthood with Alcohol and substance abuse
- Adult problems have more serious consequences ex. Impulsivity, reckless driving, retaining and long term relationship, and substance abuse.
- Most severe long term neuro – developmental disorder
- 2 times more likely in adults
V. Treatment
1. Medication
- Three major classes include stimulant, non-stimulant, and anti –depressant for associated anxiety.
- Stimulant such as methylphenidate(Ritalin and Concerta) similar to norepinephrine and dopamine work in 70%. Recommendation for treatment vary depending on age. (more than 6 years old)
- How do they work?
- Side effects include loss of appetite, mood swings, high blood pressure, and fast heart rate.
- Table 4 current treatments approved for ADHD
- non stimulant drugs such as atomoxetine(Strattera) act as a norepinephrine reuptake inhibitor.
- Anti-depressant associated in mood disorder.
- Goal of therapy is to maximize benefits while minimizing side effects.
- An association between stimulants and long term cardiac risks uncertain, despite concern.
- Of all the treatment, medical treatment has the most beneficial effects.
2. Behavioral intervention
- Behavioral parent training and behavioral classroom management improve child ability to control his/her behavior in academics
- Long term positive effect are yet to be determined but it increases work productivity and decreased disruptive behavior.
- The combination of medication and behavioral therapy was promising in lowering dosage and reducing side effects.
- alternative treatment
- Avoided junk food may help prevent nutritional imbalance as well as avoiding refined sugars, processed foods, and additives. Exercise and sports enhance brain activity and can improve ADHD.
- Nutritional supplements and herbal remedies uncertain.
VI. Conclusion