Pediatrics Book

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Attention Deficit DisorderAka: Attention Deficit Hyperactivity Disorder, ADHD, Attentional Disorders

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

Attention Deficit Disorder (C0041671)

Definition (CSP)behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity; although most individuals have symptoms of both inattention and hyperactivity-impulsivity, one or the other pattern may be predominant; symptoms often attenuate during late adolescence although a minority experience the full complement of symptoms into mid-adulthood.
ConceptsMental or Behavioral Dysfunction (T048)
MSHD001289
EnglishADD - Attention deficit disorder, ATTENTION DEFICIT DIS, Attention Deficit Disorder, Attention Deficit Disorders, Attention deficits, Undifferenciated attention deficit disorder, Undifferentiated attention deficit disorder
SpanishTDA indiferenciado, trastorno por deficit de atencion indiferenciado, trastorno por falta de atencion indiferenciado
Parent ConceptsAttention deficit hyperactivity disorder (C1263846), Child Behavior Disorders (C0008066), Child Mental Disorders (C0178546), Mental disorders (C0004936), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, MSH, MTH, NCI, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Attention deficit hyperactivity disorder (C1263846)

Definition (MSH)A behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. Although most individuals have symptoms of both inattention and hyperactivity-impulsivity, one or the other pattern may be predominant. The disorder is more frequent in males than females. Onset is in childhood. Symptoms often attenuate during late adolescence although a minority experience the full complement of symptoms into mid-adulthood. (From DSM-IV)
ConceptsMental or Behavioral Dysfunction (T048)
ICD9314, 314.01, 314.9, 314.9
MSHD001289
EnglishADD - Attention deficit disorder with hyperactivity, ADDH, ADHD, ADHD - Attention deficit disorder with hyperactivity, ATTENTION DEFICIT DIS WITH HYPERACTIVITY, Attention deficit disorder of childhood with hyperactivity, Attention Deficit Disorder with Hyperactivity, Attention Deficit Disorders with Hyperactivity, ATTENTION DEFICIT HYPERACTIVITY DIS, Attention deficit hyperactivity disorder, Attention Deficit Hyperactivity Disorders, Attention deficit hyperkinetic disorder, ATTENTION DEFICIT-HYPERACTIVITY DISORDER, ATTN DEFICIT W HYPERACT, childhood hyperkinetic syndrome, hyperactive child syndrome, HYPERACTIVITY OF CHILDHOOD, Hyperkinetic disorder, HYPERKINETIC SYNDROME, Hyperkinetic syndrome of childhood, Overactive child syndrome, SYNDROME HYPERKINETIC, Unspecified hyperkinetic syndrome of childhood
Spanishsindrome del nino hiperactivo, sindrome hiperquinetico, TDAH, trastorno de hiperactividad con deficit de atencion, trastorno por deficit de atencion con hiperactividad
Parent ConceptsAttention Deficit Disorder (C0041671), [X]Mental and behavioral disorders (C0556006), Child attention deficit disorder (C0004269), NEUROTIC DISORDERS, PERSONALITY DISORDERS, AND OTHER NONPSYCHOTIC MENTAL DISORDERS (C0338608), Attention deficit hyperactivity disorder (C1263846), Attention Deficit and Disruptive Behavior Disorders (C0236964), Mental disorders (C0004936), Disruptive Behavior Disorder (C0012734), Disorders of attention and motor control (C0454623), Ambiguous concept (C1274012)
SourcesAOD, CSP, CST, ICD9CM, MEDLINEPLUS, MSH, MTH, MTHICD9, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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