Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood with symptoms of hyperactivity, impulsivity, and/or inattention.
The symptoms affect cognitive, academic, behavioral, emotional, and social functioning prevalence of ADHD in children has been increasing higher among children living in nonmetropolitan areas compared with large central metropolitan areas.
ADHD affects more men than women, with a ratio of 4:1
Children and adolescents with ADHD frequently have comorbid psychiatric, sleep and neurodevelopmental disorders like oppositional defiant disorder (ODD), conduct disorder, depression, anxiety disorder, autism spectrum disorder (ASD), learning disorders, obstructive sleep apnea, restless leg syndrome and parasomnias.
Oppositional defiant disorder is seen in approximately 50 to 80 percent of children. Excessive activity, impulsive response style, and unrestrained emotional expression frequently resulted in conflict with parents and siblings. The increased conflict may lead to increased discipline and less positive reinforcement for the child (the oppositional acts bring parental attention, which is reinforcing for the child who rarely receives parental praise).
Obstructive sleep apnea (OSA) is a common cause of daytime sleepiness, as well as cognitive and behavioral symptoms similar to ADHD. Overt difficulty waking or drowsiness are less common in children than in adults. Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) in children can both be characterized by behavioral symptoms such as hyperactivity, inattention, and difficulty focusing. Pathogenesis of ADHD is not definitively known. A genetic imbalance of catecholamine metabolism in the cerebral cortex appears to play a primary role increased risk of ADHD in first-degree relatives of patients with ADHD.
ADHD diagnosis
l Be present in multiple settings (eg, school and home)
l Persist for at least six months
l Manifest before the age of 12 years
l Interfere with academic, social, or occupational functioning,
l Exceed the expected developmental level of the child
l Not result from other mental disorders
A small subset of children may exhibit mild adverse behaviour or inattention when eating diets high in food additives, artificial colors, excess sugar, or low in essential fatty acids and minerals such as iron and zinc. Insufficient sleep may exacerbate symptoms of ADHD.
Prenatal exposure to certain medications like antidepressants, valproate for epilepsy and acetaminophen are associated with increased risk of ADHD. Smoking in pregnancy increases risk of ADHD.
Prematurity and low birth weight are linked to ADHD.
Most ADHD symptoms fluctuate between childhood and young adulthood, with intermittent periods of remission and recurrence.
ADHD diagnosed in childhood is associated with an increased risk of intentional and unintentional injury, substance abuse, and motor vehicle crashes among drivers.
Children with ADHD may require changes to their educational program, such as tutoring, resource room support, classroom
modifications, or direct skills training for adolescents.
Attention deficit hyperactivity disorder (ADHD) treatment involves education of patients, caregivers, and teachers regarding the diagnosis and treatment. Coexisting conditions must be treated in conjunction with ADHD. Psychosocial interventions, medication, and/or educational approaches may be used separately or in combination. Patients and caregivers should make therapy decisions.
(The author, Dr. Shiva Kumar R, is a Head and Senior Consultant – Neurology, at Manipal Hospital.)
