Attention deficit hyperactivity disorder ( ADHD ) is a mental disorder of the developmental type of nerve. It is characterized by attention problems, excessive activity, or difficulty controlling behavior that is not appropriate for a person's age. Symptoms appear before a person of twelve years, present for more than six months, and cause problems in at least two settings (such as school, home, or recreational activities). In children, attention problems can lead to poor school performance. Although it causes disruption, especially in modern society, many children with ADHD have a good attention span for tasks they find attractive.
Although mental disorders are most frequently studied and diagnosed in children and adolescents, the exact cause is unknown in most cases. It affects about 5-7% of children when diagnosed through DSM-IV and 1-2% criteria when diagnosed through ICD-10 criteria. By 2015 it is estimated to affect around 51.1 million people worldwide. Prices are similar among countries and are highly dependent on how it is diagnosed. ADHD is diagnosed about three times more frequently in boys than girls, although the disorder is often overlooked in girls because their symptoms differ from boys. Approximately 30-50% of people diagnosed in childhood continue to have symptoms into adulthood and between 2-5% of adults have the condition. This condition can be difficult to distinguish from other conditions, as well as to distinguish from high levels of activity that are still within the range of normative behavior.
ADHD management recommendations vary by country and usually involve some combination of counseling, lifestyle changes, and medications. The UK Guidelines only recommend drugs as first-line treatment in children who have severe symptoms and medications should be considered in those with moderate symptoms that reject or fail to improve counseling, although for adult treatment is first-line treatment. Canadian and American guidelines recommend that medications and behavioral therapy be used together as first-line therapy, except in preschoolers. Drug stimulant therapy is not recommended as first-line therapy in preschool children in both guidelines. Treatment with effective stimulant up to 14 months; However, its long-term effectiveness is unclear. Adolescents and adults tend to develop coping skills that shape some or all of their disorders.
Medical literature has described symptoms similar to ADHD since the 19th century. ADHD, its diagnosis, and its treatment have been considered controversial since the 1970s. Controversy involves doctors, teachers, policy makers, parents, and the media. Topics include the causes of ADHD and the use of stimulant drugs in its treatment. Most health care providers accept ADHD as a nuisance in children and adults, and the debate in the scientific community is mainly centered on how it is diagnosed and treated. This condition was officially known as attention deficit disorder ( ADD ) from 1980 to 1987, while before this was known as a childhood hyperkinetic reaction .
Video Attention deficit hyperactivity disorder
Signs and symptoms
Less attention, hyperactivity (adult anxiety), disruptive behavior, and general impulsivity occur in ADHD. Academic difficulties often occur like problems with relationships. The symptoms can be difficult to define, as it is difficult to draw a line where the level of lack of attention, hyperactivity, and normal impulsivity and significant levels that require intervention begins.
According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), symptoms should be present for six months or longer for a much greater degree than others at the same age and they should cause problems significantly works in at least two settings (eg, social, school/workplace, or home). Complete criteria must be met before the age of twelve to receive ADHD diagnosis.
ADHD is divided into three subtypes: negligible predominant (ADHD-PI or ADHD-I), predominantly hyperactive-impulsive (ADHD-PH or ADHD-HI), and combined type (ADHD-C).
A child with ADHD negligent type has most or all of the following symptoms, excluding situations where these symptoms are better explained by psychiatry or other medical conditions:
- Easily distracted, skip details, forget about things, and move from one activity to another a lot
- Difficulty maintaining focus on one task
- Get bored with the task after just a few minutes, except doing something they think is fun
- Difficult to concentrate on organizing or completing tasks
- Have difficulty completing or submitting homework assignments, often losing things (eg, pencils, toys, tasks) needed to complete a task or activity
- Apparently not listening while talking to
- Daydream, becomes easily confused, and moves slowly
- Have trouble processing information fast and accurate like others
- Struggle to follow instructions
- Have problems understanding details; facing details
A child with hyperactive-impulsive ADHD type has most or all of the following symptoms, excluding situations in which these symptoms are better explained by other psychiatric or medical conditions:
- Restless or wriggling
- Talk nonstop
- Run around, touch or play with anything and everything that looks
- Difficulty sitting quietly at dinner, school, doing homework, and story time
- Keep moving
- Have trouble doing quiet tasks or activities
- Be impatient
- Cover inappropriate comments, show their emotions unhindered, and act without attention to consequences
- Difficulty waiting for things they want or waiting their turn in game
- Frequently interrupts other people's conversations or activities
Girls with ADHD tend to show hyperactive symptoms and fewer impulses but more symptoms related to lack of attention and attention disorders. Hyperactivity symptoms tend to go with age and turn into an "inner anxiety" in adolescents and adults with ADHD.
People with ADHD of all ages are more likely to have problems with social skills, such as social interaction and shaping and maintaining friendships. This applies to all subtypes. About half of children and adolescents with ADHD experience social rejection by their peers compared with 10-15% of children and adolescents who are not ADHD. People with attention deficits tend to have difficulty processing verbal and nonverbal languages ​​that can negatively affect social interaction. They may also drift during conversation, loss of social cues, and difficulty learning social skills.
Difficulty managing anger is more common in children with ADHD such as poor handwriting and delays in speech, language and motor development. Although it causes significant difficulties, many children with ADHD have the same or better attention span than other children for tasks and subjects they find interesting.
Related interruptions
In children, ADHD occurs with other disorders about two thirds of the time. Some generally related conditions include:
- Epilepsy
- Tourette's syndrome
- Autistic spectrum disorder (ASD): this disorder affects social skills, communication skills, behavior, and interests.
- Anxiety disorders are found to be more common in ADHD populations.
- Learning disabilities have been found to occur in about 20-30% of children with ADHD. Learning disabilities may include speech impairment and developmental language and impaired academic skills. ADHD, however, is not considered a learning disability, but very often leads to academic difficulties.
- Obsessive-compulsive (OCD) may occur simultaneously with ADHD and share many of its characteristics.
- Disturbance of substance use. Adolescents and adults with ADHD are at an increased risk of substance abuse. This is most often seen with alcohol or marijuana. The reason for this may be the modified gift path in the individual brain of ADHD. This makes the evaluation and treatment of ADHD more difficult, with serious substance abuse problems usually treated earlier because of greater risk.
- Sleep disturbances and ADHD generally co-exist. They can also occur as side effects of drugs used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder with preferred treatment behavior therapy. Problems with sleep initiation are common among individuals with ADHD but often they will sleep soundly and have significant difficulty waking up in the morning. Melatonin is sometimes used in children with sleeping onset of insomnia.
- Opposing Opposing Disorder (ODD) and behavioral disorders (CD), which occur with ADHD in about 50% and 20% of cases respectively. They are characterized by antisocial behavior such as stubbornness, aggression, frequent outrage, deception, lying, and stealing. About half of those with hyperactivity and ODD or CD develop antisocial personality disorder in adulthood. Brain imaging supports behavioral disorders and ADHD is a separate condition.
- Primary vigilance disorders, characterized by poor attention and concentration, and difficulty staying awake. These children tend to be restless, yawning and stretching and looking hyperactive to stay alert and active.
- slow cognitive tempo (SCT) is a group of symptoms that potentially comprise other attention disorders. This can occur in 30-50% of cases of ADHD, regardless of subtype.
- Mood disorders (especially bipolar disorder and major depressive disorder). Boys who are diagnosed with a combined ADHD subtype are more likely to have a mood disorder. Adults with ADHD sometimes also have bipolar disorder, which requires careful assessment to diagnose and treat both conditions accurately.
- Restless leg syndrome has been found to be more common in those with ADHD and is often caused by iron-deficiency anemia. However, restless legs can only be part of ADHD and require careful assessment to distinguish between the two disorders.
- People with ADHD have an increased risk of excessive bedwetting.
- A systematic review of 2016 found an established relationship between ADHD and obesity, asthma and sleep disturbance, and provisional evidence for association with celiac and migraine diseases, while other 2016 systematic reviews do not support a clear link between celiac disease and ADHD, that routine screening for celiac disease in people with ADHD is not recommended.
Intelligence
Overall, studies have shown that people with ADHD tend to have lower scores on intelligence tests (IQ). This significance is controversial because of the difference between people with ADHD and difficulty determining influences of symptoms, such as distractibility, on scores lower than intellectual capacity. In ADHD studies, higher IQs may be better represented because many studies exclude individuals who have a lower IQ even though those with an average ADHD score are nine points lower on standardized intelligence measurements.
Maps Attention deficit hyperactivity disorder
Cause
Most cases of ADHD are unknown causes. It is believed to involve interactions between genetics, the environment, and social factors. Certain cases are associated with previous infection or trauma to the brain.
Genetics
Twin studies show that this disorder is often inherited from a person's parents with genetics that determine about 75% of cases. Siblings of children with ADHD are three to four times more likely to develop a disorder than unbalanced siblings of children. Genetic factors are also believed to be involved in determining whether ADHD continues into adulthood.
Usually, a number of genes are involved, many of which directly affect the neurotransmission of dopamine. Those involved with dopamine include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. The common variant of a gene called LPHN3 is estimated to be responsible for about 9% of cases and when this variant is present, people are very responsive to stimulant drugs. 7 recurrent variants of dopamine D4 receptor (DRD4-7R) cause an increased dopamine-induced inhibitory effect and are associated with ADHD. The DRD4 receptor is a protein-coupled G receptor that blocks adenylyl cyclase. The DRD4-7R mutation produces a variety of behavioral phenotypes, including ADHD symptoms that reflect shared attention.
Evolution may play a role in high levels of ADHD, especially the hyperactive and impulsive properties in men. Some people hypothesize that some women may be more interested in risk-taking men, increasing the frequency of genes that affect hyperactivity and impulsivity in the gene pool. Others claim that these traits may be adaptations that help men deal with stressful or dangerous environments with, for example, improvements in impulsive behavior and exploration. In certain situations, ADHD characteristics may be beneficial to society as a whole even when it is endangering the individual. High levels of ADHD and heterogeneity may have improved reproductive fitness and benefited people by adding diversity to gene pools despite harming individuals. In certain environments, some properties of ADHD may have offered individual benefits to individuals, such as a faster response to predators or superior hunting skills.
People with Down syndrome are more likely to have ADHD.
Environment
In addition to genetics, several environmental factors may play a role in causing ADHD. Alcohol intake during pregnancy can lead to fetal alcohol spectrum disorders that may include ADHD or similar symptoms. Children exposed to certain toxic substances, such as lead or polychlorinated biphenyls, can develop problems that resemble ADHD. Exposure to chlorpyrifos organophosphate insecticides and dialkyl phosphate is associated with increased risk; However, the evidence is not conclusive. Exposure to tobacco smoke during pregnancy can cause problems with the development of the central nervous system and may increase the risk of ADHD.
Extremely premature births, very low birth weight, and extreme neglect, harassment, or social deprivation also increase risks such as certain infections during pregnancy, at birth, and in early childhood. These infections include, among others, various viruses (measles, varicella zoster encephalitis, rubella, enterovirus 71). There is a relationship between long-term but not short-term use of acetaminophen during pregnancy and ADHD. At least 30% of children with traumatic brain injury then develop ADHD and about 5% of cases are caused by brain damage.
Some studies have shown that in a small number of children, artificial food dyes or preservatives can be associated with an increased prevalence of ADHD or ADHD symptoms, but evidence is weak and only applies to children with food sensitivity. The UK and the EU have implemented regulatory measures based on this concern. In a small percentage of children, intolerance or allergies to certain foods can aggravate the symptoms of ADHD.
Research does not support the popular belief that ADHD is caused by consuming too much processed sugar, watching too much television, parents, poverty or family chaos; However, they may aggravate the symptoms of ADHD in certain people.
Society
In some cases, ADHD diagnosis may reflect dysfunctional families or poor education systems, rather than problems with the individual itself. In other cases, this can be explained by increasing academic expectations, with diagnosis being a method for parents in some countries to gain additional financial and educational support for their children. The youngest children in the classroom have been found more likely to be diagnosed as having ADHD probably because they are developing behind their old friends. Typical behavior of ADHD occurs more often in children who have experienced violence and emotional abuse.
ADHD's social construction theory suggests that because of the boundaries between "normal" and "abnormal" socially constructed behaviors (ie jointly created and validated by all members of society, and especially by doctors, parents, teachers, etc.) it then follows the subjective judgments and assessments determining the diagnostic criteria used and, thus, the number of people affected. This may lead to a situation in which the DSM-IV arrives at ADHD levels three to four times higher than those obtained with ICD-10. Thomas Szasz, a proponent of this theory, argues that ADHD ""... was created and then named ".
Pathophysiology
Current ADHD models suggest that this is associated with functional impairment in some brain neurotransmitter systems, especially those involving dopamine and norepinephrine. The pathways of dopamine and norepinephrine are derived from the ventral tegmental area and locus coeruleus project to different regions of the brain and regulate various cognitive processes. Dopamine pathways and norepinephrine pathways projecting to the prefrontal cortex and striatum are directly responsible for executive function modulation (behavioral cognitive control), motivation, perception of rewards, and motor function; this pathway is known to play a central role in the pathophysiology of ADHD. Larger ADHD models with additional paths have been proposed.
Brain structure
In children with ADHD, there is general volume reduction in certain brain structures, with a proportional decrease in volume in the left side prefrontal cortex. The posterior parietal cortex also shows thinning in ADHD individuals compared with controls. Other brain structures in prefrontal-striatal-cerebellum and prefrontal-striatal-thalamic circuits are also found to be different between people with and without ADHD.
Neurotransmitter path
It was previously thought that an increase in the number of dopamine carriers in people with ADHD was part of the pathophysiology but it appears that the increased number is due to adaptation to stimulant exposure. Current models involve the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. Psdostimulan ADHD has medicinal properties because they increase neurotransmitter activity in this system. There may also be abnormalities in the serotoninergic, glutamatergic, or cholinergic pathways.
Executive function and motivation
ADHD symptoms arise from lack of certain executive functions (eg, attention control, inhibition control, and working memory). The executive function is a set of cognitive processes necessary to successfully select and monitor behaviors that facilitate the attainment of a person's chosen goals. Impaired executive functionalities that occur in ADHD individuals lead to problems by staying organized, keeping time, procrastinating, maintaining concentration, paying attention, ignoring disorders, managing emotions, and remembering details. People with ADHD seem to have uninterrupted long-term memory, and deficits in long-term memory seem to be associated with impairments in working memory. Criteria for executive function deficit are met in 30-50% of children and adolescents with ADHD. One study found that 80% of individuals with ADHD experience impairment in at least one executive functional task, compared with 50% for individuals without ADHD. Because of the maturation rate of the brain and the increasing demand for executive control as one gets older, ADHD disorders may not fully manifest themselves until adolescence or even early adulthood.
ADHD is also associated with a motivational deficit in children. Children with ADHD often find it difficult to focus on the long-term on short-term benefits, and show impulsive behavior for short-term benefits.
Diagnosis
ADHD is diagnosed with an assessment of the child's mental and behavioral development, including excluding the effects of drugs, medications and other medical or psychiatric problems as an explanation for symptoms. This often takes into account feedback from parents and teachers with most diagnoses started after a teacher raises concerns. This can be seen as the extreme end of one or more of the sustainable human traits found in all people. Whether a person responds to the drug does not confirm or rule out the diagnosis. As brain imaging studies do not provide consistent results between individuals, they are only used for research purposes and not diagnoses.
In North America, the DSM-5 criterion is used for diagnosis, while European countries typically use ICD-10. With DSM-IV criteria the diagnosis of ADHD is 3-4 times more likely than ICD-10 criteria. It is classified as a neurodevelopmental psychiatric disorder. In addition, it is classified as a disruptive behavioral disorder along with opposition rebel interference, behavioral disorder, and antisocial personality disorder. Diagnosis does not imply a neurological disorder.
Related conditions to be examined include anxiety, depression, opposition rebel interference, behavioral disorders, and learning and language disorders. Other conditions to consider are other neurodevelopmental disorders, tics, and sleep apnea.
The diagnosis of ADHD using quantitative electroencephalography (QEEG) is an ongoing area of ​​investigation, although QEEG values ​​in ADHD are currently unclear. In the United States, the Food and Drug Administration has approved the use of QEEG to evaluate ADHD morbidity.
Self-rating scales, such as ADHD ranking scales and ADandex Vanderbilt diagnostic rating scales, are used in ADHD screening and evaluation.
Manual Diagnostics and Statistics
Like many other psychiatric disorders, formal diagnosis should be performed by qualified professionals based on a set number of criteria. In the United States, this criterion is determined by the American Psychiatric Association at DSM. Based on the DSM criteria, there are three sub-types of ADHD:
- A very neglected type of ADHD (ADHD-PI) develops with symptoms including irritability, forgetfulness, daydreaming, disorganization, poor concentration, and difficulty completing tasks.
- ADHD, a predominantly hyperactive-impulsive type with excessive anxiety and anxiety, hyperactivity, difficulty waiting and staying seated, immature behavior; destructive behavior can also be present.
- ADHD, a composite type is a combination of the first two subtypes.
This division is based on at least six of the nine long-term symptoms (at least six months) of inattention, hyperactivity-impulsivity, or both. To be considered, symptoms should appear at age six to twelve and occur in more than one environment (eg at home and at school or workplace). Symptoms should be inappropriate for children of that age and there should be clear evidence that they are causing social, school or work related problems.
International Classification of Diseases
In the tenth revision of the International Statistical Classification of Diseases and Health Problems Related (ICD-10) by the World Health Organization, symptoms of "hyperkinetic disorder" analogous to ADHD in DSM-5. When a behavioral disorder (as defined by ICD-10) is present, this condition is referred to as hyperkinetic behavior disorder . Otherwise, this disorder is classified as an activity and attention disorder , other hyperkinetic disorder or hyperkinetic disorder, not specific . The latter is sometimes referred to as hyperkinetic syndrome .
In the initial draft for ICD-11 (planned for 2018), ADHD is classified under Attention Deficit hyperactivity disorder and all seem to be completely identical now with DSM-5.
Adult
Adults with ADHD are diagnosed with the same criteria, including that their signs should be present at the age of six to twelve. Questioning a parent or guardian about how the person is behaving and developing as a child can be part of the assessment; ADHD family history also increases the weight of the diagnosis. While the core symptoms of ADHD are similar in children and adults they often appear different in adults than in children, eg excessive physical activity seen in children can present as anxiety and constant mental activity in adults.
It is estimated that between 2-5% of adults have ADHD. Approximately 25-50% of children with ADHD continue to experience ADHD symptoms until adulthood, while the rest have fewer or no symptoms. Today, most adults remain untreated. Many adults with ADHD without diagnosis and treatment have an irregular life and some use non-prescribed drugs or alcohol as a coping mechanism. Other issues may include relationships and job difficulties, and an increased risk of criminal activity. The associated mental health issues include: depression, anxiety disorders, and learning disabilities.
Some ADHD symptoms in adults differ from those seen in children. While children with ADHD may climb and run excessively, adults may experience an inability to relax, or they over-talk in social situations. Adults with ADHD may initiate impulsive relationships, display sensation-seeking behaviors, and become irritable. Addictive behaviors such as substance abuse and gambling are common. The DSM-V criterion specifically deals with adults, unlike those in DSM-IV, which are criticized for being inappropriate for adults; those presented differently can lead to claims that they are beyond the diagnosis.
Differential diagnosis
Symptoms of ADHD, such as low mood and poor self-image, mood swings, and irritability, can be confusing with dysthymia, cyclothymia or bipolar disorder as well as with impaired personality thresholds. Some of the symptoms caused by anxiety disorders, antisocial personality disorders, developmental defects or mental retardation or substance abuse effects such as intoxication and withdrawal may overlap with some ADHD. This disorder can sometimes occur simultaneously with ADHD. Medical conditions that may cause ADHD type symptoms include: hyperthyroidism, seizure disorders, lead toxicity, hearing deficit, liver disease, sleep apnea, drug interactions, untreated celiac disease, and head injury.
Primary sleep disorders can affect attention and behavior and symptoms of ADHD can affect sleep. It is therefore recommended that children with ADHD are regularly assessed for sleep problems. Sleepiness in children can lead to symptoms ranging from the classic yawning and rubbing the eyes, to hyperactivity and not attention. Obstructive sleep apnea can also cause symptoms of ADHD type.
Biomarker Research
Reviews from ADHD biomarkers have noted that platelet monoamine oxidase expression, urinary norepinephrine, urinary MHPG, and urinary phenethylamine levels are consistently different between ADHD individuals and healthy controls. These measurements potentially serve as diagnostic biomarkers for ADHD, but more research is needed to establish their diagnostic utility. Plasma phenethylamine concentrations and blood plasma were lower in ADHD individuals relative to control and the two most commonly prescribed drugs for ADHD, amphetamine and methylphenidate, increased the biosynthesis of phenethylamine in ADHD-responsive individuals. Lower urinary phenethylamine concentrations are also associated with symptoms of inattention in ADHD individuals. Electroencephalography (EEG) is not accurate enough to make a diagnosis.
Management
ADHD management usually involves counseling or drugs either alone or in combination. While treatment can improve long-term outcomes, it does not rule out completely negative results. The drugs used include stimulants, atomoxetine, alpha-2 adrenergic receptor agonists, and sometimes antidepressants. In those who have difficulty focusing on long-term rewards, a large amount of positive reinforcement improves task performance. ADHD stimulants also increase persistence and task performance in children with ADHD.
Behavioral therapy
There is good evidence for the use of behavior therapy in ADHD and they are the first-line treatment recommended for those with mild symptoms or preschool ages. Psychological therapy used include psychoeducation, behavioral therapy, cognitive behavioral therapy (CBT), interpersonal psychotherapy, family therapy, school-based interventions, social skills training, peer behavioral intervention, organizational training, parental management training, and neurofeedback. Parental training can improve a number of behavioral problems including oppositional and noncompliant behavior. It is unclear whether neurofeedback is useful.
There is little high-quality research on the effectiveness of family therapy for ADHD, but the available evidence suggests that it is similar to community care and better than placebo. ADHD-specific support groups can provide information and can help families cope with ADHD.
Social skills training, behavior modification and treatment may have some limited beneficial effects. The most important factors in reducing later psychological problems, such as severe depression, crime, school failure, and substance use disorders are the formation of friendships with people who are not involved in naughty activities.
Regular physical exercise, especially aerobic exercise, is an effective adjunctive treatment for ADHD in children and adults, especially when combined with stimulant drugs, although the best intensity and type of aerobic exercise to improve current symptoms is unknown. In particular, the long-term effects of regular aerobic exercise on ADHD individuals include better behavior and motor skills, improved executive function (including attention, inhibitory control, and planning, among other cognitive domains), faster information processing speeds, and better memory. Parent-teacher ratings of behavioral and socio-emotional outcomes in response to aerobic exercise regularly include: better overall function, reduced ADHD symptoms, better self-esteem, reduced anxiety and depression, fewer somatic complaints, academic behavior and better classes, and better social behavior. Exercising while taking stimulant drugs adds stimulant drug effects to executive function. It is believed that the short-term effects of this exercise are mediated by the increase in synaptic amounts of dopamine and norepinephrine in the brain.
Medication
Stimulant medication is a pharmaceutical treatment option. They have at least some effect on symptoms, in the short term, about 80% of people. Methylphenidate appears to improve symptoms as reported by teachers and parents. Stimulants can also reduce the risk of unintentional injury in children with ADHD.
There are a number of non-stimulant drugs, such as atomoxetine, bupropion, guanfacine, and clonidine that can be used as an alternative, or added to stimulant therapy. There are no good studies comparing different drugs; However, they appear to be more or less the same with respect to side effects. Stimulants appear to improve academic performance while atomoxetine does not. Atomoxetine, due to a lack of addiction responsibility, may be preferred in those at risk of using recreational or compulsive stimulants. There is little evidence of drug effects on social behavior. Until June 2015, the long-term effects of ADHD drugs have not been fully determined. Magnetic resonance imaging studies show that long-term treatment with amphetamine or methylphenidate decreases abnormalities in brain structure and function found in subjects with ADHD.
Guidelines on when to use drugs differ in each country, with the UK's National Institute for Best Health and Nursing (NICE) recommends child-only use in severe cases, although for adult treatment is first-line treatment. While most US guidelines recommend drugs in most age groups. Drugs are not recommended for preschoolers. Underdoses of stimulants may occur and result in a lack of response or loss of effectiveness later. This is very common in adolescents and adults because the approved dose is based on school-age children, causing some practitioners to use based on weight or benefit based off-label doses instead. School-age boys are twice as likely as their female counterparts to take medication, while among adults, women are far more likely to take medication than men.
While stimulants and atomoxetine are usually safe, there are side effects and contraindications to their use. There is low quality evidence of the relationship between methylphenidate and both serious and non-serious side effects when taken by children and adolescents. Careful monitoring of children while taking this drug is highly recommended. A large overdose of ADHD stimulants is commonly associated with symptoms such as stimulant psychosis and mania. Although very rare, in therapeutic doses, this incidence appears to occur in about 0.1% of individuals in the first few weeks after starting amphetamine therapy. The administration of antipsychotic drugs has been found to effectively resolve the symptoms of acute amphetamine psychosis. Routine monitoring has been recommended in those who undergo long-term care. Stimulant therapy should be stopped periodically to assess sustainable needs for treatment, reduce the likelihood of delayed growth, and reduce tolerance. Abuse of long-term stimulant drugs at doses over the therapeutic range for the treatment of ADHD is associated with addiction and dependence. Untreated ADHD, however, is also associated with an increased risk of substance use disorders and behavioral disorders. The use of stimulants seems to reduce this risk or not have an effect on it. The safety of these drugs in pregnancy is unclear.
Diet
Food modification may benefit some children with ADHD. A meta-analysis of 2013 found less than one-third of children with ADHD noticed some symptom improvement with free fatty acid supplementation or decreased feeding of artificial food colorings. This benefit may be limited to children with sensitivity to food or those who are simultaneously treated with ADHD medication. This review also found that the evidence does not support removing other foods from food to treat ADHD. A review of 2014 found that the elimination diet produced little overall benefit. The 2016 review states that the use of a gluten-free diet as a standard ADHD treatment is not recommended. Iron, magnesium, and iodine can also affect the symptoms of ADHD. There is a small amount of evidence that lower tissue zinc levels may be associated with ADHD. In the absence of shown zinc deficiency (which is rare outside developing countries), zinc supplementation is not recommended as a treatment for ADHD. However, zinc supplements can reduce the minimal effective dose of amphetamine when used with amphetamines for the treatment of ADHD. There is evidence of the simple benefits of supplementing omega 3 fatty acids, but it is not recommended as a substitute for traditional medicine.
Prognosis
ADHD continues to mature in about 30-50% of cases. Those exposed tend to develop mechanisms of treatment as they mature, thus compensating to some extent for their previous symptoms. Children with ADHD have a higher risk of unintentional injury. Drug effects on functional impairment and quality of life (eg reduced accident risk) have been found in some domains. However, learning disorders and executive function deficits do not seem to respond to ADHD medications.
Epidemiology
ADHD is thought to affect about 6-7% of people aged 18 and under when diagnosed by DSM-IV criteria. When diagnosed through the ICD-10 criteria level in this age group it is estimated to be about 1-2%. Children in North America appear to have higher levels of ADHD than children in Africa and the Middle East; This is believed to be a different diagnosis method than the difference in the underlying frequency. If the same diagnostic method is used, the rate is more or less the same between countries. It is diagnosed about three times more often in boys than in girls. The differences between the sexes may reflect differences in vulnerability or that women with ADHD tend to be diagnosed compared to men.
The rate of diagnosis and treatment has increased in the UK and the United States since the 1970s. This is believed to be mainly due to changes in how conditions are diagnosed and how easily people are willing to treat them with drugs rather than correct changes in how common conditions are. It is believed that changes to diagnostic criteria by 2013 with the release of DSM-5 will increase the percentage of people diagnosed with ADHD, especially among adults.
History
Hyperactivity has long been a part of the human condition. Sir Alexander Crichton describes the "mental anxiety" in his book An investigation of the nature and origin of mental disorders written in 1798. ADHD was first clearly described by George Still in 1902.
The terminologies used to describe conditions have changed over time and have included: in DSM-I (1952) "minimal brain dysfunction," in DSM-II (1968) "childhood hyperkinetic reactions," and in DSM-III (1980) "attention-deficit disorder (ADD) with or without hyperactivity." In 1987 it was changed to ADHD in DSM-III-R and DSM-IV in 1994 dividing the diagnosis into three subtypes, ADHD negligent type, hyperactive-impulsive ADHD type and ADHD-type combined. These terms are stored in DSM-5 in 2013. Other terms include "minimal brain damage" used in the 1930s.
The use of stimulants to treat ADHD was first described in 1937. In 1934, Benzedrine became the first amphetamine drug approved for use in the United States. Methylphenidate was introduced in the 1950s, and deideroamphetamine enantiopure in the 1970s.
Society and culture
ADHD, its diagnosis, and its treatment have been controversial since the 1970s. Controversy involves doctors, teachers, policy makers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior with the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant drugs in children, the method of diagnosis, and the possibility of overdiagnosis. In 2009, the National Institute for Health and Nursing Excellence, while recognizing controversy, stated that the current care and diagnostic methods are based on the dominant view of the academic literature. By 2014, Keith Conners, one of the earliest advocates for distraction recognition, speaks against overdiagnosis in the New York Times article. In contrast, a review of 2014 peer-reviewed medical literature suggests that ADHD is under-diagnosed in adults.
With varying degrees of diagnosis in different countries, state, race, and ethnic states, some suspicious factors other than the presence of ADHD symptoms play a role in the diagnosis. Some sociologists consider ADHD as an example of the medication of deviant behavior, that is, the rotation of a school's previous school performance problem. Most healthcare providers receive ADHD as a nuisance, at least in a small number of people with severe symptoms. Among healthcare providers, the debate primarily centers on the diagnosis and treatment of more people with mild symptoms.
References
External links
- Attention deficit hyperactivity disorder in Curlie (based on DMOZ)
- National Mental Health Institute at ADHD
- New Zealand MOH Guidelines for Assessment and Treatment of Attention-Deficit/Hyperactivity Disorder
- Parameter of AACAP Practices for the Assessment and Treatment of attention deficit hyperactivity disorder
- Faraone, Stephen V.; Asherson, Philip; Banaschewski, Tobias; Biederman, Joseph; Buitelaar, Jan K.; Ramos-Quiroga, Josep Antoni; Rohde, Luis Augusto; Sonuga-Barke, Edmund J. S.; Tannock, Rosemary; Franke, Barbara (August 6, 2015). "Attention-deficit/hyperactivity disorder". Nature Review Disease Primers . 42 : 15020. doi: 10.1038/nrdp.2015.20. PMC 2146979 .
Source of the article : Wikipedia
0 Comments