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Attention Deficiency Hyperactive disorder


OVERVIEW OF Attention Deficiency Hyperactive disorder :

It is a neurodevelopmental disorder with impact on normal functioning.Attention-deficit/hyperactivity disorder (ADHD) is a disorder which implies ongoing process  of simultaneous pattern of inattention and hyperactivity impulsivity that interferes with the normal fumction of the person.

  • Inattention difficulty to focus,wanders off, lacks persistencevand is disorganized.
  • Hyperactivity :it means a persontend sto overact or move constantly In an inappropriate situations.

Impulsivity means a person make the hasty action s without thinking regarding the future outcomes and does not care about the others and engage them in this activities for desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences


EPIDEMIOLOGY :

  • Epidemiology: Neurologic disorder affecting 5% of the population.


CAUSES :

Genes:

The etiology for ADHD  involves the genetic causes. The gene is inherited from the parents.

Brain function and anatomy:

Anatomical difference in ADHD by scanning involves alternate small and larger areas in brain anatomy

Some suggest that impaired neurotransmitter also plays an important role conducting this disease.

Toxic substances such as lead

Chemical substances in the brain are out of control which leads to attention deficiency disorder in  children

               Risk groups :

Premature babies(before the 37th week of pregnancy) and low weight

Brian damage: Injury to the brain caused by the which happened either in the womb or after a severe head injury .

The three types of the attention deficiency hyperactive disorder includes:

A.Primarily hyperactive impulsive disorder ADHD  

B.Primarily inattentive disorder ADHD

C.Primarily combined type ADHD

They act fast and driven by motors. They tend to talk at inappropriate times,do the things without thinking about its impact in future,moving around.

They have impatient behaviour and tends to interrupt in others work

B.Primarily inattentive disorder ADHD:

They have difficult in focusing and feel difficult in doing the normal tasks. They get easily distracted and and forgetfulnees is higher in them.This kind of patient tends to get un noticed since they do not disturb the environment surrounding them.

C.Primarily combined type ADHD:

This type of people includes both the combination of Primarily inattentive disorder ADHD and Primarily hyperactive impulsive disorder.


PATHOPHYSIOLOGY :

Alteration in the dopaminergic and adrenergic group of drugs.

Prefrontal areas tends to be infected.

Dopaminergic and Adrenergic are neurotransmitters the substances which take part in the transmission of impulses.The person with attention deficiency hyperactive disorder tends to display overaction of the neurotransmitters.these leads to salience and loss of memory.


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Often fail to give close attention and lacks the focus in activities.
  • Has some difficulty in sustaining attention in certain acts and other playing activities.(has difficulty in reading in lenghthy conversations and or lengthy readings.
  • They wont listen when someone spokes.(mind seems anywhere and they do not have any clear mind)
  • Has difficulty in organizing task and activities.(they tend to do activities in disorganized manner)
  • Often losses the things that are required for the certain activities.
  • Often fails to follow the instructions. When started they were eager to work and at last they loses the function and cease to work
  • Often avoids the task which requires thinking ability.
  • Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
  • Day dreaming
  • Interrupting and procrastinate the work


DIAGNOSTIC :

It is best to complete one of these rating scales to help diagnose ADHD. The most common of these tests are completed by the child's parents and usually include:

A)Conners' Parent Rating Scales, which asks about the child's symptoms.

B)Vanderbit ADHD rating scale

The Conners CBRS is for assessing children ages 6 to 18. It’s specially formatted to help determine if:

  • the student qualifies for inclusion or exclusion in special education
  • the treatment or intervention is effective
  • ADHD is a concern
  • response to the treatment is positive
  • what treatment plans may work best

Separate forms are available for parents, teachers, and the child. The short version is 25 questions and can take 5 minutes to an hour to complete. The long version is used for ADHD evaluation and monitoring progress over time. Scores above 60 indicate ADHD. Your doctor will also convert those scores into percentile scores for comparison

B)Vanerbit rating scale:

This scale is used for the people with age group of 6-12 years.The scoring is done.A score of 4 for higher than 2 questions and score of 5 for 1 questions indicates ADHD.

  • Child Behavior Checklist, which evaluates a wide range of symptoms.

Teachers also are often asked to complete rating scales, such as:

  • Conners' Teacher Rating Scales, used to evaluate the child's symptoms in the classroom.
  • Child Behavior Checklist/Teacher Report Form, which also evaluates classroom behavior.
  • Child Attention Problems, which monitors behavioral changes when the child is taking medicine to treat ADHD.
  • DSM-5 criteria:

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

    1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
    2.  Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions.
    3. For older adolescents and adults (age 17 and older), at least five symptoms are required.
    4. a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
    5. b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
    6.  c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
    7. d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
    8.  e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
    9.  f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
    10.  g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
    11.  h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
    12.  . Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
    13.  Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a. Often fidgets with or taps hands or feet or squirms in seat.
    14.  Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place.`
    15. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
    16.  Often unable to play or engage in leisure activities quietly. e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
    17.  Often talks excessively. g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
    18.  Often has difficulty waiting his or her turn (e.g., while waiting in line). i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
    19. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
    20. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
    21. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
    22.  The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).


TREATMENT AND PROGNOSIS :

Treatment of the autism include multidisciplinay approach.

Therapies:

Applied Behavioural analysis including  positive behavioural approach:

Includes training the parents ,teachers,school faculties and other peer group of the child affected with this disease.

Cognitive behavioural therapy:it includes the stress management in the children and also relieve them from their anxiety and obsessive repetative behaviours.This therapy also focuses on the child’s emotional disturbances.

Medications:they are indicated mainly to treat the major depressive disorder and anxiety disorder.

Occupational oe physical theyapy:They mainly indulge in sensory processing and motor coordination behaviour of the child.

Social communication therapy:it includes the speech therapy to help pragamatics.

 Inspite of the social skills training and occupational therapy the improvement is purely

Depends upon the individual and their peer groups.

Medications:

The drugs acting on the central nervous system paves the way for the ADHD

Drugs:methyphenidate and amphetamine based drugs-CNS stimulants

 Atomoxetine and Buprion-CNS depressants


PREVENTION :

  • eat a healthy and balanced diet
  • get at least 60 minutes of physical activity per day
  • get plenty of sleep
  • limit daily screen time from phones, computers, and TV
  • follow medications and have an relaxed mind.


Recovery Period :

These problems tend to resolve within age.And it become reduced when the child attains the adulthood.


Medicines used in the Treatment :

Methyphenidate

amphetamine based drugs

Atomoxetine

 Buprion


REFERENCE :

NICHQ caring children with healthcare issues

http://cdc.goc.in

http://healthline.in

attitudemag.com

sciencedaily.com