An
Overview on Attention Deficit Hyperactivity Disorder
Ruth
Salomi K., Ramesh N., Hepcy Kala Rani D. and Ravindra Reddy K.
P. Rami Reddy
Memorial College of Pharmacy-Kadapa-516 003, Andhra Pradesh, India.
ABSTRACT:
Attention - deficit hyperactivity disorder (ADHD)
is a self explanatory condition that people of all ages are afflicted with, all
over the world. It is classified as a neurobehavioral development disorder
which more commonly affects about to 5% of children. It consists of the core
symptoms of inattention, impulsivity and hyperactivity. ADHD and its symptoms
can be recognized at an early stage and with proper treatment a normal life can
be experienced.
KEYWORDS: inattention, hyperactivity, impulsivity.
INTRODUCTION1:
Attention deficit hyperactivity disorder also called as
ADHD is a genetically determined condition that affects those spots of the
brain that control attention, impulses and concentration. It is thought to
affect 3-7% of school age children but does also affect adults. The best
description of ADHD is that a person who has this condition shows disruptive
behaviors which cannot be explained by any other psychiatric condition and are
not in keeping with those of the same aged people with similar intelligence and
development. These behaviors are usually first noticed in early childhood and
they are more extreme than simple “misbehaving” .People with ADHD have
difficulty focusing their attention to complete a specific task. Additionally
they can be hyperactive and can suffer from mood swings and “social
clumsiness”.
ADHD develops in childhood and is most commonly noticed
at the age of five. Research suggests that 80% of children diagnosed with ADHD
continue to experience symptoms during adolescence and 67% continue to have
symptoms into adulthood.
Types of ADHD:2
There are three types of ADHD. They are defined
according to which symptoms stand out the most.
v Predominantly
Inattentive Type: Affected person
finds it very difficult to organize or finish a task. They find it hard to pay
attention to details and find it difficult to follow instructions or
conversations.
v Predominantly
Hyperactive-Impulsive Type:
Affected person finds it hard to keep still. They fidget and talk a lot. A
small child may be continually jumping, running or climbing. They are restless
and impulsive, interrupting others, grabbing things and speaking at
inappropriate times. They have difficulty waiting for their turn and find it
hard to listen to directions. A person with this type of ADHD will have more
injuries and accidents than others.
v Combined
Type: A person has all the
symptoms which are noticed in the above types. These symptoms are equally
predominant.
Related conditions:3
As many as one
third of children with ADHD have one or more additional or coexisting
conditions. Adults with ADHD show an even higher incidence. The most common of
these are anxiety, depression, bipolar disorder, behavioral problems, and
learning and language disabilities.
Causes:4
The specific cause of ADHD is not known.
There are however a number of factors that may contribute to ADHD. They include
genetics, diet, social and physical environments.
Ø Genetic factors:
Studies indicate that the disorder is highly
heritable and that genetics is a factor in about 75% of ADHD
cases. Hyperactivity also seems to be primarily a genetic condition where;
other causes also have an effect.
Researchers believe that a large majority of
ADHD cases arise from a combination of various genes, many of which affect
dopamine transporters. Candidate genes include dopamine transporter, dopamine
receptors D2/D3, dopamine beta-hydroxylase monoamine
oxidase A, catecholamine- methyl transferase, serotonin transporter promoter
(SLC6A4), 5-hydroxytryptamine 2A receptor (5-HT2A), 5-hydroxytryptamine 1B
receptor (5-HT 1B), the 10-repeat allele of the DAT1 gene, the 7-repeat allele
of the DRD4 gene and the dopamine beta hydroxylase gene (DBH Taq1).
The broad selection of targets indicates
that ADHD does not follow the traditional model of “a genetic disease” and
should therefore be viewed as a complex interaction among genetic and
environmental factors. Even though all these genes play a role, to date,
no single gene has been shown to make a major contribution to ADHD.
Ø Environmental Factors:
Environmental factors implicated include
alcohol and tobacco smoke exposure during pregnancy and environmental exposure
to lead in very early life. The relation of smoking to ADHD could be due to
nicotine causing hypoxia (lack of oxygen) to the fetus in utero. It could also
be that women with ADHD are more likely to smoke and therefore, due to the
strong genetic component of ADHD they are more likely to have children with
ADHD. Complications during
pregnancy and birth including premature birth also play a role. ADHD patients
have been observed to have higher than average rates of head injuries. However, current evidence does not
indicate that head injuries are the cause of ADHD in the patients. Infections
during pregnancy, at birth and in early childhood are linked to an increased
risk of developing ADHD. These include various viruses (measles,
varicella, rubella, enterovirus 71) and streptococcal bacterial infection.
Ø Diet:
A study conducted by researchers at
Southampton University in the United Kingdom found a definitive link between
children’s ingestion of many commonly used artificial food colors, the
preservative sodium benzoate and hyperactivity.
Ø Social Factors:
The world Health Organization states that
the diagnosis of ADHD can represent family dysfunction or inadequacies in the
educational system rather than individual psychopathology. Other
researchers believe that relationships with caregivers have a profound effect
on attentional and self-regulatory abilities. A study of foster children states
that a high number of them had symptoms closely resembling ADHD33. Researchers
have found behavior typical of ADHD in children who have suffered violence and
emotional abuse. Furthermore, Complex Post Traumatic stress Disorder
can result in attention problems that can look like ADHD. ADHD is
also considered to be related to sensory integration dysfunction.
Ø Brain
injury:5
Brain injury may also be a cause of attention
deficit hyperactivity disorder in some very small minority of children. This is
due to exposure to toxins or physical injury either before or after birth .Head
injuries can cause ADHD like symptoms in previously unaffected people perhaps
due to frontal lobe damage.
Symptoms:6
The most common symptoms associated with
ADHD are impulsiveness which means that they act purely on impulse with no
thought for their actions what so ever. They also have scattered
thoughts, organization of their critical faculties as well as the tendency to
interrupt people or even themselves during conversation. This is
characteristic of a nerve of emotions and impulses, a sort of overriding of
their conscious mental faculties of critical thought, rationale appraisal and the
normal defenses of awareness. They tend to pace up and down the room
looking for things to do, unable to fixate their concentration on any one thing
for long, They also manifest their hyperactivity with physical actions
like constant tapping of their fingers, shaking of their legs and even the
inability to sleep. The last most common symptom of attention deficit
hyperactivity disorder is inattention.
Neurology:7
The most recent models describing what is
happening neurologically in the brains of people with Attention Deficit
Hyperactivity Disorder suggest that several areas of this brain may be affected
by the disorder.
They include:
§ Frontal Lobes
§ Inhibitory Mechanisms of the Cortex
§ Limbic System
§ Reticular Activating System
Each of these areas of the brain is
associated with various functions of the brain.
Above is a sample Q-EEGs of two Attention
Deficit Hyperactivity Disorder children compared to two non- ADHD children.
ADHD children show excessive slow brainwave
activity (theta and alpha ranges) compared to non-ADHD activity. The slow
brainwave activity indicates a lack of control in the cortex of the brain.
“Lack of control” is pretty descriptive of
Attention Deficit Hyperactivity Disorder kids.
Diagnosis:8
There is no simple test (like a blood test
or a short written test) to determine whether someone has ADHD or not this
is true of many medical conditions (for example, there is no “test” for a
simple headache, yet anyone who has had a headache knows it’s real!).
Accurate diagnosis is made only by trained
clinician after an extensive evaluation. This evaluation should include
ruling out other possible causes for the symptoms involved a through physical
examination and a series of interviews with the individual(child or adult) and
other key persons in the individual’s life (for example, parents, spouse,
teachers, and others).
As ADD is a medical condition it should be
diagnosed by a pediatrician, neurologist, psychiatrist, psychologist, clinical
social worker or other properly licensed mental health professional who has
experience evaluating and treating individuals with ADHD.
Treatment:9
There is no cure for ADHD, however,
many treatment approaches may alleviate or significantly decrease ADHD
symptoms. As a result, improvements are evident in school or work
performance, relationships with others improve and self esteem.
No single treatment works for every
individual. Some people respond well to medications, some to behavioral
interventions and many respond to combination of the two. Counseling, education
and support services are often helpful. Typically, a multimodal approach
to treatment works best.
v Medications:
Stimulant medications have been found to be
effective in alleviating ADHD symptoms. Common stimulants include
Ritalin, Dexedrine, Concerta, Metadate, Focalin, and Adderall. Some
people respond better to one kind of stimulant while others do not. While
stimulants are typically the first choice of medication, there are several
non-stimulants that may be prescribed. These include Atomoxetine, Tricyclic
antidepressants and Bupropion. It is important for individuals on medication to
be medically supervised. Effectiveness of medication, side effects,
dosages etc need to be monitored.
v Behavioral Strategies and Interventions:
A chaotic, unstructured, unorganized setting
can exacerbate symptoms. On the flip side, a setting that is structured,
predictable, and motivating can greatly help. Many people with ADHD also
respond well to reward system with clear consequences for behaviors. Positive
behaviors are rewarded with the goal of increasing the occurrence of them.
Negative behaviors may receive consequences with the goal of decreasing
them. This type of system is called behavior modification and it has
found to work well with children and many adults.
v Parent Training:
ADHD can be exhausting. Parents dealing with
children having ADHD may benefit from education and training. This
training gives parents tools and techniques for managing behavior problems at
home. Parents may also benefit from support and acknowledgement that they are
on the right track.
v Social Skills Training:
Social skills training focuses on helping an
individual with ADHD learn new, more appropriate behaviors and ways of
interacting with others. The goal is to improve the basic ways an
individual relates and interacts with others on a daily basis.
v Counseling or Psychotherapy:
It provides an individual with ADHD a place
to process feelings and develop strategies for dealing with the effects of
ADHD. ADHD often results in broken friendships poor relationships, and a
plunging self-esteem.
v Coaching:
It helps to create daily structure and
organization by providing support and encouragement to set goals and rewards
and keep them focused even when obstacles occur.
v Support Groups:
People, either loved ones of those with ADHD
such as parents, spouses etc., as well as individuals with ADHD may find
strength, education and encouragement in support groups. Sharing with others
who are going through the same situations can be a tremendous booster.
If an individual does not respond to a multi
treatment approach, the original diagnosis of ADHD should be reviewed.
Coexisting conditions that may be contributing to the lack of improvement
should also be reassessed. The individual’s family and school compliance
with the treatment approach should also be evaluated.
CONCLUSION:
Attention Deficit Hyperactivity Disorder
provides many blessings as well as difficulties. Attention Deficit children
tend towards creativity and are unique problem solvers. The greatest
intervention of all that an authority figure can provide is that of role
modeling. For instance, speaking aloud to the child what it is that the
authority figure is doing with a transition is a great way to demonstrate
constructive uses of time. Telling the child where and how the parent or
teacher feels anger and how they plan to channel it constructively also
benefits the child. It is not a curse but a blessing in that it
encourages all of us to think about our motivations and drives. Sharing of the
self is the most precious gift of all.
REFERENCES:
1.
http://www.enotalone.com/article/3085.html
2.
http://www.medicalnewstoday.com/info/adhd/whatisadhd.php
3.
http://add.about.com/od/relatedconditions/Related_Conditions.htm
4.
http://en.wikipedia.org/wiki/Attention-deficit
hyperactivity disorder
5.
http://psychcentral.com/lib/2007/causes-of-attention-deficit-disorder-adhd/
6.
http://www.thefreelibrary.com/learn+more+about+attention+deficit+disorder+sympto
ms-a01073996045
7.
http://newideas.net/adhd/neurology
8.
http:/www.theglp.org/ADD_info.html
9.
http://add.about.com/od/treatmentoptions/a/ADHDtreatment.htm
Received on 21.05.2010
Accepted on 12.06.2010
© A&V Publication all right reserved
Research J. Pharmacology and
Pharmacodynamics. 2(5): Sept.-Oct. 2010, 317-320