Bisc 150 - Adhd and Its Treatment

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 

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