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Attention Deficit Hyperactivity Disorder (ADHD)

| February 12, 2012 | 1 Comment

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood symptoms include difficulty staying focused and paying attention, different controlling behaviour and over-activity. It is a developmental disorder affecting about 3 to 5 percent of children globally (Nair et al, 2006). In the UK, a survey of 10,348 children between the ages of 5 and 15 years discovered that 3.62% of boys and 0.85% of girls had ADHD (Ford et al., 2003).There are three subtypes of this disorder: predominantly hyperactive-impulsive, predominantly inattentive, combined hyperactive-impulsive and inattentive.

The most common symptoms include; inattention, hyperactivity and impulsivity. Inattention signifies a disorganised style preventing sustained effort; hyperactivity suggests a restless and shifting excess of movement; and impulsivity implies premature and thoughtless actions. In order to be diagnosed with the disorder a child must have symptoms for 6 months or more. The core behaviours of ADHD are typically present from before the age of 7 years (Sayal et al., 2002). Although scientists are not sure what causes ADHD, many studies suggest that genes play a large role (Faraone et al, 2005). Twin studies indicate that the disorder is highly heritable and that genetics play an important factor in about 75 percent of cases (NICE, 2008). No single gene has been identified in connection with ADHD; rather several DNA variants of small effect. They each increase the susceptibility of ADHD by a small amount. Biological, psychosocial and dietary factors also play an important role in determining ADHD development.

Although treatments can relieve many of the disorder’s symptoms, there is no particular cure. The most common type of medication used for treating ADHD is called a “stimulant”. The treatment has a calming effect on children with ADHD. However what works for one child might work for another. These stimulant medications come in different forms such as a pill, capsule, liquid or skin patch. Those referred for assessment for ADHD generally receive a specialist clinical assessment by a psychiatrist or paediatrician. The reason for this is to rule out any undiagnosed disorders with symptoms that in rare instances may mimic or cause some key aspects of ADHD. Treatments and interventions for ADHD may vary and they may be provided in a variety of settings.

 

Psychological therapies

These include behavioural therapies such as Cognitive behavioural therapy (CBT), family therapy, interpersonal therapy and school-based interventions. They help encourage the development of coping strategies and for managing the behavioural disturbance of ADHD (Taylor et al., 2004).

 

Medication

In theUK, the three most common types of drugs licensed to be used in the treatment of ADHD are; atomoxetine, dexamfetamine and methylphenidate. According to The NICE technology appraisal, these medications are effective in controlling the symptoms of ADHD relative to no treatment (NICE, 2006). The most commonly  reported side effects of these medications include: decreased appetite and  sleep problems, although they may also vary from child to child.

ADHD is a common disorder that affects 3 to 5 percent of children worldwide. The main symptoms include; inattention, hyperactivity and impulsivity. There is no single cause for ADHD, however genetic and environmental factors play an important part in its development.

 

References

Faraone, S.V., Perlis, R.H., Doyle, A.E., Smoller, J.W., Goralnick, J.J., Holmgren, M.A., and Sklar, P (2005). Molecular genetics of attention deficit/ hyperactivity disorder. Biological Psychiatry, 57, 1313-1323.

Ford, T., Goodman, R., and Meltzer, H. (2003). The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. Journal of theAmericanAcademyof Child and Adolescent Psychiatry, 42, 1203-1211.

Nair, J., Ehimare, U., Beitman, B.D, et al (2006). Clinical review: Evidence-based diagnosis and treatment of ADHD in children. 103, (6): 617 -21.

NICE (2006) Methylphenidate, atomoxetine, and dexamfetamine for the treatment of attention deficit hyperactivity disorder in children and adolescents. Technology Appraisal 98. London: NICE. Available at: www.nice.org.uk/TA98.

NICE (2008) Diagnosis and Management of ADHD in children, young people and adults. National Clinical Practice Guideline Number 72.

Sayal, K.,Taylor, E., Beecham, J., et al (2002) Pathways to care in children at risk of attention deficit hyperactivity disorder. The British Journal of Psychiatry, 181, 43-48.

Taylor, E., Doepfner, M., Sergeant, J., et al. (2004) European clinical guidelines for hyperkinetic disorder: first upgrade. European Child and Adolescent Psychiatry, 13, Suppl. 1-30.

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