Symptoms of ADHD

Attention Deficit and Hyperkinetic Disorders (ADHD) is a mental disorder that affects the behavior or development of young children, men and women. Following are the Symptoms of ADHD found in children by Age of 7:

Inattention

Hyperactive

Impulse

Many children with ADHD cannot explain why they are out of control or feel very alone. This condition is more common in boys than girls.

There are 3 types of ADHD:

Mainly inattention, most children cannot concentrate.

Mainly hyperactive or impulsive, children often have hyperactive or impulsive behavior.

In the mixed type, the child exhibits a mixture of inattention and hyperactivity or impulsivity.

ADHD in Adults

Attention deficit and hyperkinetic disorders (ADHD) have long been a common reason for consultations in primary care and pediatric specialists, and more recently, have expanded to include adult psychiatrists, neurologists, and internists. It is estimated that children diagnosed with ADHD account for 50% of clinical cases in child psychiatry. Proper diagnosis and treatment are of paramount importance due to the potential impact of a diagnosis on an individual's present and future functioning of life.

Diagnosis Procedure

The main symptoms of ADHD are: short attention span compared with other people of the same mental age, impulsiveness (acting without thinking about the consequences of actions), easily distracted (inability to focus on things that need to be done), restlessness (restless movement) . According to the Diagnostic and Statistical Manual of Mental Disorder IV (DSM-IV) criteria (listed in Table 1), these characteristics can be divided into two main categories (inattentive and hyperactive-impulsive). Abnormal behaviors usually begin before the age of 7, and some symptoms can be seen even before school age. Usually, at least 6 months of observation are required to rule out changes in behavior patterns caused by environmental or psychosocial stress. ADHD behaviors must be observed in different settings and frequently occur in school, family, social and work settings.

Read more on following research based topics: 

Do you Know that Your Blood Group Define your personality.  

You can also be victim of Heart Diseases OR Heart Attack without Symptoms

Just Follow few rules and Stay Healthy for the Rest of Life

What are the 5 Beauty Tips for Women Skin

Prepare not breakfast but Healthy Breakfast for your children

What is Mental Health Awareness OR Mental Health Disorder

Effective way to Get Ride of Hiccups

What is Few Common Causes of Hair Loss

What is most enssential Green Tea Health Benefits for your body

Criteria for Diagnosing ADHD

A. Meet (1) or (2)

(1)     

·        Six (or more) of the following attention-deficit symptoms persist for at least 6 months to an extent that is contrary to normal child development lack of attention

·        Frequent inability to focus on details, schoolwork, work, or other activities

·        Frequent difficulty maintaining concentration during work or play activities

·        Often seem to be out of hearing when speaking to him

·        Frequent non-compliance with directions and inability to complete schoolwork, chores, assigned responsibilities at work (not due to defiant behavior or ignorance of directions)

·        Often have difficulty organizing work or activities

·        Frequent avoidance, dislike, and reluctance to engage in tasks that require constant mental effort (such as schoolwork or homework)

·        Frequent loss of items needed for work or activities (eg, toys, school assignments, pencils, books, tools)

·        Often distracted by external objects

·        Frequent forgetfulness during daily activities

(2)

• Six (or more) of the following hyperactive-impulsive symptoms persist for at least 6 months to an extent that is contrary to normal child development

overactive

• Frequent fidgeting, fidgeting, or moving around in chairs

• Frequently leaves seat in classroom or other situations where sitting is required

• Frequent running or climbing up and down in inappropriate places (teens or adults may experience only personal feelings of restlessness)

• Often unable to play quietly or participate in leisure activities

• Often ready to go, or appear to have a motor installed

• Often talk too much

• Impulsive

• Often rushes to answer questions before they are finished

• Often can't wait to take turns

• Often interrupts or meddles in other people's activities (such as conversations or games)

B. Some hyperactivity - symptoms of impulsivity or inattention appear before age 7.

C. Some symptoms cause problems in two or more settings (such as at school or work and at home).

D. There must be clear evidence of clinically significant social, academic, or occupational harm.

E. Symptoms are not associated with a worsening developmental disorder (Pervasive Developmental Disorder), schizophrenia (Schizophrenia), or other psychotic disorder (Psychotic disorder) caused by, nor by another mental disorder (such as mood disorders, anxiety disorders or personality disorder)

ADHD Type Codes

Comprehensive

Those who met the A1 and A2 criteria in the past 6 months

Attention deficit

Those who met A1 but not A2 criteria in the past 6 months

Hyperactive - Impulsive

Those who met A2 criteria but not A1 criteria in the past 6 months

Notes on the code: Those whose current symptoms do not meet all the criteria (especially adolescents and adults) should add "Partial Remission" (In Partial Remission).

Preschool children typically show a marked increase in activity, with additional impulsive traits such as rage, aggression, and argumentative behavior, and an increased risk of accidental injury. Many such children have trouble falling asleep or sleeping. Because of the child's impulsive and irritable personality, it often causes tension in peer relationships. Possible comorbidities are anxiety, developmental language disorder, autism, and cognitive impairment.

School-age children with ADHD often have academic difficulties. Possibly markedly poor peer relations and social immaturity. Typical symptoms in adolescents are disorganization rather than hyperactivity. While hyperactivity and impulsivity decrease, other ADHD features remain. Patients have difficulty completing tasks and may be overly keen on risk-taking and impulsive behavior, reflected in an increased rate of automobile accidents.

Symptoms in adults with ADHD do not necessarily meet all established pediatric criteria, but also present with dysfunction in the same domains of DSM IV. They are persistently characterized by inattention and impulsivity, with hyperactive symptoms often seen as inner restlessness. Problems of everyday life include: organizational difficulties (work, home and child care), forgetfulness, risk taking (smoking and drug abuse, car accidents), social difficulties (marital/relationship problems, lack of skills), and in education and job hunting difficulties (increased dropout and unemployment rates, lack of college and job-seeking plans, low academic and work achievement) (see table).

What are the Signs of ADHD

Reference feature affects on

Poor concentration academic performance

Poor organizational skills Workplace / work ability

Tendency to not get work done Relationships

Attention deficit financial management

Poor school performance

Poor time management Family management

Difficulty controlling temper Disciplining children

Impulsive health

Difficulty working Range of daily activities (self-limiting)

Rating scales are helpful in part of the assessment of individuals with ADHD. Broadband tools include ADHD in more complete psychological surveys (eg, Achenbach Children's Behavior Checklist ). The narrow band covers ADHD specifically. Common rating scales for children and adolescents are the Conners Parent and Teacher Rating Scales, the ADHD Rating Scale, and the Venderbilt Assessment Scale (available at www available from the ADHD Toolkit at .nichq.org). Adult rating scales include symptom screening and diagnostic scales, such as ADHD Rating Scale-IV (adult version) (ADHD Rating Scale-IV, adult adaptation), ADHD Adult Self-Rating Scale (Adult ADHD Self-Report Scale) (​https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf), Barkley's Current Symptom Scale, Wender Utah Rating Scale ), Conners Adult ADHD Rating Scale (Conners Adult ADHD Rating Scales), and Brown Adult ADD Scale (Brown Adult ADD Scale). In addition to the Wender Utah scale which has branched off from existing standards, more recently developed scales are based on the DSM standards. The Wender Utah scale is less sensitive for detecting the inattentive form, cannot be used in adults with comorbidities, and may overlap with conduct and mood disorders.

Evaluation for possible ADHD is as follows:

The presence of ADHD features that consistently affect function and meet diagnostic criteria, including use of rating scales. This information should come from multiple sources (personal, family, teachers, work colleagues, and friends) and historical records (record cards, school assessments, psychological tests).

Identify features of ADHD that have been present since childhood, particularly in the preschool or early school years.

Refer to prenatal, birth, and growth records for possible causes of ADHD, as well as their timing and severity.

Differentiate from other possible diagnoses (psychological and medical) and identify associated comorbidities (see below).

Psychological and neurological medical history in the family.

Perform a physical examination to look for underlying conditions that may be causing conditions similar to ADHD (hyperstress, endocrine disorders) and associated neurological abnormalities (dyspraxia, cerebral palsy, movement disorders).

Comorbidities include oppositional-defiant disorder and behavioral norm disturbance. Some children with behavioral norm disorder go on to develop antisocial behavior and alcohol/drug abuse. Other associated symptoms include developmental motor coordination disorder, developmental language disorder in preschool age, learning disabilities in school age, emotional dysregulation, and anxiety disorders. ADHD may be the first feature of Tourette syndrome or tic disorder, which usually occurs in school age and occurs in about 10-12% of cases. ADHD features of severe mood lability may first appear in children with bipolar disorder before manifesting overt symptoms of bipolar disorder.

Conditions similar to ADHD are listed in Table 3. An actual history and examination are needed to confirm the underlying disease.

Table 3 ADHA - Differential Diagnosis

Conditions similar to ADHD

Depression

Bipolar disorder

Anxiety disorder

Autism

sleep disorder

learning disability

peripheral sensory deficit (auditory and/or visual)

Epilepsy

Cognitive deficiency

conduct disorder

Oppositional-defiant disorder

Difficult child

drug effect

Epidemiology

The prevalence of ADHD in school-age children is 3-10%. Some studies point to ADHD predominance in boys, but girls with no diagnosed ADHD-attention-deficit type may contribute to the undercounting of girls with ADHD. Symptoms persist into adulthood in about 50% of children with ADHD, with a male to female ratio of 1:1. Family history is often strongly associated with diagnosed or undiagnosed ADHD.

Both congenital and acquired factors may contribute to ADHD (Table 4). Beta adrenergic drugs (albuterol), anticonvulsants (Phenobarbital, carbamazepine, valproate, gabapentin), and theophylline may trigger behaviors that cannot be identified with ADHD.

Table 4 ADHD - Etiology

ADHD caused by congenital or acquired factors

idiopathic/genetic

Hypoxic-ischemic encephalopathy

closed head injury

CNS infection: encephalitis, meningitis

Inborn errors of metabolism

Exotic toxin

stroke

Chromosomal abnormalities

drug effect

Many names have been used to describe this group over the years, including mild brain injury, mild brain dysfunction (including ADHD, motor coordination difficulties, and language learning disabilities). These children may be labeled hyperkinetic syndrome (hyperkinetic syndrome) in the UK and deficits in attention, motor control and perception (DAMP) in Scandinavia. group.

Neurobiology

The attention center in the brain is responsible for orientation, detection, alertness, and focus shifting. Anatomical locations include the frontal region, anterior cingulated region, posterior parietal areas, superior colliculus and thalamus. Neuroanatomy found that patients with ADHD had a smaller corpus callosum volume. Functional neuroimaging studies found a brain-wide decrease in glucose metabolism (primarily in the premotor area and upper prefrontal cortex) in positron emission computed tomography (PET) studies, Decreased perfusion in the striatum and increased perfusion in the sensory and sensorimotor regions were found. These neuroimaging studies suggested that the dysfunction occurred in the frontal-striatonuclear-cerebellar neural circuit, and there was also some evidence of generalized brain volume loss.

Most of the neurochemical studies on ADHD believe that dopamine, norepinephrine (norepinephrine) metabolism is abnormal. Adults with ADHD have increased concentrations of dopamine transmitters. ADHD in animals leads to changes in the brain's catecholamine system during development. ADHD's clinical response to stimulant drugs that affect catecholamine systems also suggests disturbances in these systems.

Genetic studies have found that this syndrome and related disorders occur in early familial and close family members. Research on adoption and twin studies have also confirmed the involvement of genes. Although no specific gene was identified, there is evidence that the dopamine D2 receptor, dopamine transmitter, and D4 dopamine receptor genes are involved.

How to Treat ADHD?

Dealing with ADHD requires a two-pronged approach that combines behavioral education techniques with the proper use of medication. Findings from the Multimodal Therapy Study of Children with ADHD also support this conclusion. This study found that the core symptoms of ADHD were best treated with appropriate doses of medication, while ADHD-induced outcomes (school performance, relationships with peers and family, self-esteem) were improved with a combination of medication and behavioral/educational interventions. Follow-up follow-up found that the efficacy of the drug continued but decreased. Behavioral interventions include psychosocial interventions that focus on the home, school, child, teaching parenting skills, and providing support in diverse settings. Academic intervention requires an organized environment and well-trained educators who understand that children with short attention spans need structure, discipline, and a clear approach to education. These include increasing class and exam time, shrinking homework units, and reducing distractions from foreign objects. Using a schedule, daily teacher feedback and incentives can also be effective. At home, interventions should focus on using verbal or practical rewards to encourage good behavior rather than focusing solely on correcting bad behavior. Reward and encouragement methods may also need to change frequently. Behavioral interventions should also focus on aggressive interventions to manage comorbidities, such as oppositional defiant disorder, anxiety, or depression.

Likewise, nonpharmacologic treatments for adults with ADHD include strategies for understanding executive dysfunction. Psychosocial interventions teach how to improve organizational skills, relationships, and daily habits. Changing academic and work environments can improve patient performance.

Medications have been successful in improving attention, thereby reducing distraction and hyperactivity in 80-90% of children and adolescents with ADHD, and in 70% of adults with ADHD. Although a long-term study of children with ADHD complex showed that medication for core symptoms was far more effective than behavioral therapy, epidemiological data suggest that many children with ADHD are not receiving adequate medication. The main drugs and recommended initial dosage are listed in Table 4.

CNS activator drugs (methylphenidate, amphetamine, and pemoline) have been found to improve attention better than antidepressants or alpha adrenergic agents, and are therefore recommended as first-line treatment. In addition, these drugs can reduce defiant behavior and improve patients' ability to interact with others around them. Whether the medication needs to be taken on a daily basis or only in special situations (school, work, social contact) must be determined on an individual basis. Children with concurrent behavioral and peer relationship problems should take daily medication. Likewise, adolescents and adults with widespread symptoms and interfering with normal functioning are better treated around the clock. Medication can reduce the risk of substance abuse in adolescents. Methylphenidate has the same effect as amphetamines. Everyone responds differently to a drug, and if a person doesn't respond well to one drug, another drug should be tried.

Table 4 ADHD Medication

Classification Daily dosage Time of consumption Action time

Methylphenidate 0.3 – 2 mg/kg

IR 2-4 times daily for 3-4 hours

ER used once in the morning

Metadate CD 8 hours

Ritalin LA 8 hours

Concerta 12 hours

d-Methylphenidate 0.15 – 1 mg/kg two to three times daily for 4 hours (6 hours?)

Amphetamine 0.15 – 1.5 mg/kg

IR use once in the morning - twice daily

ER used once in the morning

Dexedrine Spansule 6 - 8 hours

Adderall XR 12 hours

Most patients can tolerate some side effects, if any. At first they may complain of transient headaches and stomach pains, which can be improved by taking them with meals. Other side effects, such as decreased appetite and insomnia, are usually short-lived. About 10% of children (and fewer adults) have sleep disturbances that require further treatment. Some people must discontinue treatment because their mood worsens beyond mild dysesthesia. As the effect of the drug wears off, there may be a "rebound" hyperactivity lasting 35-40 minutes. This phenomenon can be improved by replacing short-acting drugs with long-acting central nervous system activators. Convulsions (tics) may occur during drug use, although research does not suggest that this is the cause of exacerbated tics. In most children with tics, the frequency and severity of tics changes slightly over time, regardless of whether the drug is continued or stopped. Low-dose treatments have positive effects on cognition and attention, while high-dose treatments, while effective in improving behavior, may cause "cognitive toxicity". In patients with well-controlled epilepsy, treatment with methylphenidate does not exacerbate epilepsy symptoms. Children taking CNS activator drugs should have their height and weight measured regularly because these drugs may cause poor appetite and growth delay, especially in tall children who are taking daily drugs. It is not clear whether this is a transient effect, with rapid growth that disappears by puberty, or a slight but permanent delay in growth. It is recommended that adults take regular weight, blood pressure, and pulse measurements. CNS activator drugs should not be used together with monoamine oxidase inhibitors (MAOI's). There are reports that pemoline can cause liver toxicity after several months of use, and liver function needs to be tested regularly. It is not recommended to use it in the first or second line of treatment.

Concern has been raised about the potential relationship between the use of CNS activators and the subsequent development of drugs of abuse. Long-term follow-up studies have found that ADHD patients, especially those with concurrent behavioral norm disorder, have a higher chance of substance abuse in adolescence and adulthood. Effective treatment of ADHD with CNS activators reduces this risk to the peer group without triggering substance abuse in this group. Medications may be diverted to non-ADHD patients, but this is not a serious problem.

The use of long-acting central nervous system activators has a positive effect on the treatment of ADHD. The 8-12 hour duration of action allows ADHD patients to take only one dose in the morning, no further doses at school or work (socially avoiding labelling), and provides a more even dose throughout the day, Improved compliance and parental satisfaction with medication efficacy. The 12-hour long-acting medication can help children and teens succeed at school, improve behavior after school, and adult performance at work and socially. For adults who need longer days, methylphpenidate, taken twice daily for 8 hours, may help. Therefore, when using CNS activators, prolonged drug release should be the goal of all therapeutic approaches.

Tricyclic antidepressants are about 70 percent effective in treating ADHD. It can reduce muscle overreaction, impulsivity and short attention span, and has a positive effect on anxiety and low mood. Cardiovascular side effects and sudden death caused by tricyclic antidepressants have been paid more and more attention. Bupropoion has been associated with increased seizures and may be used in people with a history of ADHD, substance abuse, or mood disorders. Venlafaxine is effective in adults with ADHD.

More recently, atomozetine, a selective norepinephrine reuptake inhibitor, has become available and appears to have a therapeutic effect on ADHD, but whether it is as effective as a CNS activator is unclear. Its side effects include tiredness, digestive discomfort, and decreased appetite. In adults, mild increases in blood pressure and heart rate, urinary retention, and sexual dysfunction may occur. Less commonly, there may be liver dysfunction, so liver function tests are recommended if jaundice or other signs of liver disease develop. Because it is metabolized by CYP2D6, poor metabolizers and those taking drugs that inhibit CYP2D6 (such as paroxetine, fluoxetine, or quinidine) may result in reduced drug efficacy. This drug should be classified as a non-CNS activator drug for first-line treatment, especially in patients who cannot tolerate or do not want to take CNS activators, or whose medical history indicates that CNS activators should not be used (including current or suspected drug abuser).

Clonidine and guanfacine are alpha andrergic agonists that are effective in children with ADHD. Most of them are used together with central nervous system activators to stabilize mood, reduce aggression and over-arousal. Avoid sedation and improve sleep with patches that release a steady concentration of clonidine throughout the day.

Other treatment models that have been promoted are as follows. Modafinil has a positive effect on response inhibition, but more research is needed to confirm this. Dietary interventions, such as reducing reliance on sugar or food, have not been proven effective except in a small number of children with apparent food sensitivities and associated adverse behaviors. Although the effects of taking large amounts of vitamins has been heard in the popular media, research results do not support this claim. Recent reports indicate that the use of electroencephalogram (EEG) biofeedback can improve focus and cognition in children with ADHD, but more research is needed before this therapy can be recommended.

Other long-term studies have shown that social, behavioral, academic interventions, or pharmacotherapy alone may not strongly alter children's behavior. The MTA study suggests that using both therapies together is more effective in treating children with ADHD; however, other studies have not found any additional benefit of adding social skills training to medication in children without significant comorbidities.

After Recovery

About 15 years ago, it was generally believed that children with ADHD would outgrow the disorder and no longer need medication by the time they were teenagers. Subsequent follow-up studies have found that approximately one-half of patients no longer have any ADHD features by adulthood. Others either continue to exhibit ADHD symptoms, interfere with daily life functioning, potentially negatively impact academic and career goals (less time in school, low job status, poor social skills), or develop serious comorbidities such as alcoholism, substance abuse and antisocial behavior. Most of the latter have behavior norm disorders in childhood, so it can be seen that childhood should be the time for interventional treatment. It is strongly recommended that patients with symptoms of ADHD should consider the continued use of pharmacological and non-pharmacological interventions.