ADHD Attention deficit hyperactivity disorder



ADHD or attention deficit hyperactivity disorder is a common neuropsychiatric disorder affecting usually younger individuals or adults. The onset is usually prior to age 12. . At least 3-4% of the general population is affected.


It is characterized by impulsivity, restlessness, inattention, emotional and executive dysfunction. Psychiatric comorbidities coexist including mood disorders and anxiety.


There are 3 predominant types, the inattentive type, the impulsive type and the mixed inattentive and impulsive type.


For the inattentive ADHD type the predominant symptoms are inattention. At least 6 of the following symptoms are required for a diagnosis. Inattention to details, difficulty sustaining attention in tasks, distracted listening, not following instructions, difficulty organizing tasks, disliking tasks that require sustained mental effort, misplacing items, being easily distractible, and forgetfulness  in daily activities.


For the hyperactivity and impulsivity type  6 or more of the following  symptoms are required. Being fidgety, leaving the seat or walking away, being restless, running or climbing when expected to be quiet  if a child, inability to engage in leisure activities quietly, always on the go, talking excessively, talking before ones turn, inability to wait in a queue, and interrupting or intruding others.


For the mixed type, at least 6 symptoms from each of two above categories are required.


ADHD is felt to be partly genetic and possibly affected by environmental influences. In some cases traumatic brain injury, and in utero insults such as exposure to maternal use of tobacco or other substances may be contributory. Excess sugar intake has however not been associated with ADHD. It is important to exclude other etiologies including absence seizures, autism, thyroid abnormalities, and other psychiatric disorders including substance use, depression, mania and psychosis. Neuropsychological evaluation may help make this diagnosis in adults.


Treatment is usually behavioral and medication based.


Maintaining a daily schedule, decreasing sources of distractions, having attainable goals, rewarding successful behavior, limiting certain choices, and using checklist and finding hobbies or sports that are interesting for a child and using calm disciplinary tactics are good steps most can easily take.


Medications for ADHD would include  (Aderall, Adderall XR) or amphetamine,  (Ritalin) or methylphenidate, (concerta or Ritalin SR) which are long acting methylphenidates,  (daytrana) a methylphenidate patch,  atomextine (straterra), (vyvanse) or lisdexamphetamine, , (Focalin) or Dexmethylphenidate, (Dexedrine) or dextroamphetamine.


Main side effects include poor appetite, insomnia, mood swings and blood pressure and heart rate increases, and potential for misuse. Discuss with your physician side effects, titrations and dosing. Drug holidays rarely can be used for long periods off school but usually are not recommended since this is a chronic disorder. This is not an option for those on straterra.  These medications may be continued for several years before a trial off  the medications are taken to ascertain if these medications need continuation.




Tips for ADHD include :


-Maintaining a daily schedule


-Decreasing sources of distractions


-Having attainable goals


-Rewarding successful behavior


-Limiting certain choices


-Using checklists


-Finding hobbies or sports that are interesting


-Using calm disciplinary tactics to help younger children.




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