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Attention Deficit Disorder
Aka: Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, ADHD, Attentional Disorders, Attention Deficit Disorder in Children- See Also
- Epidemiology
- Prevalence: 3-10% of population
- Affects 5% of school children (1 per classroom)
- More commonly diagnosed in boys than girls (4 - 8:1)
- Overlap with other learning Disability
- Other learning Disability: 10% of children with ADHD
- Learning disabled children with ADHD: 33%
- Prevalence: 3-10% of population
- Pathophysiology
- Neurobehavioral disorder of
- Inattention
- Distractibility
- Impulsivity
- Hyperactivity
- Associated problems
- Academic problems
- Social problems
- Emotional problem
- Neurobehavioral disorder of
- Signs: Inattention and Distractibility
- Greatest for tasks requiring vigilance
- Poor persistence in tasks without appeal
- Parents report:
- "Doesn't listen"
- "Can't concentrate and easily distracted"
- "Can't work without supervision"
- "Fails to finish tasks"
- "Daydreams, confused, in a fog"
- "Loses things"
- Signs: Impulsivity
- Risk taking
- Can't wait
- Parent's Report
- "Won't share"
- "Constantly interrupts"
- "Doesn't think first"
- "Has to be first"
- "Reacts emotionally"
- Signs: Hyperactivity/Overactivity
- Speech overactivity
- Motor overactivity
- Overactivity may be situational
- Parent's Report
- "Always on the go"
- "Constantly talking"
- "Loud"
- "Won't settle down"
- Associated features
- School failure (held back a grade)
- Poor planning, organization and task performance
- Speech and language problems
- Poor motor coordination
- Enuresis
- Insatiability
- High stimulus seeking
- Low frustration tolerance
- Emotional problems as listed below may coexist
- History
- Consider organic abnormality
- See ADHD Differential Diagnosis
- Perinatal complications
- Developmental delay
- Medical history
- Family History of Attention Deficit Disorder
- Consider learning Disability
- Ask educational history
- Is child reading at grade level?
- Is child's language at grade level?
- Consider cognitive testing
- Ask educational history
- Consider home environment
- Assess family stressors
- Assess family coping mechanisms
- Consider comorbid psychiatric condition
- Major Depression
- Excessive crying or worry
- Preoccupation with death or Suicide
- Conduct Disorder
- Cruelty toward people or animals
- Destruction of property or stealing
- Delinquent behavior
- Oppositional Defiant Disorder
- Frequent rule breaking or arguments with adults
- Frequently loses temper
- Tourette's Syndrome
- Repetitive vocal or Motor Tics
- Sexual abuse history
- Inappropriate sexual behavior
- Major Depression
- Consider organic abnormality
- Examination
- Complete Physical exam
- Emphasis areas
- Thyroid Examination
- Hearing Test
- Vision Test
- Neurocutaneous lesions
- Height and weight
- Neurological exam
- Diagnostics
- Not routinely recommended
- Diagnosis
- Management: General
- Management: Follow-up
- Medication list
- Medication side effects
- Medication compliance
- Target Symptom Effect (choose 3 symptoms to follow)
- Track Medication dispensed
- Document Informed Consent by Parents, Guardian
- Prognosis
- Life long disorder
- Hyperactivity decreases
- Other features continue into adulthood in 50-60%
- Academic difficulty
- Social problems
- Conduct problems
- Accidents and risk taking
- Resources
- See ADHD Resources
- References
- King (1999) Pediatric Subspecialty for Primary Care
- Sykora (2000) Capital Conference, Washington, DC
- Cantwell (1996) J Am Acad Child Adolesc Psychiatry 35
- Culbert (Dec 1993) Pediatrics in Review
- Herrerias (2001) Am Fam Physician 63(9):1803-10
- Smucker (2001) Am Fam Physician 64:817-32