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Bisc 150 - Adhd and Its Treatment

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ADHD and its treatment


  • 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.


  1. 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.
  1. 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

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