Paediatrics
ADHD
ADHD is the most common Neuropsychiatric condition in childhood and is characterized by a pattern of diminished sustained attention, and increased impulsivity or hyperactivity.
Paediatrics
What is ADHD
ADHD aka Attention Deficit Hyperactivity Disorder aka Hyperkinetic disorder is the most common Neuropsychiatric condition in childhood. It affects preschoolers, children, adolescents, and adults. ADHD is characterized by a pattern of diminished sustained attention, and increased impulsivity or hyperactivity. ADHD significantly affects academic functioning and social and interpersonal skills in the affected individuals.
ADHD can have its onset in infancy but it is rarely diagnosed until the child is at least a toddler. In an infant, ADHD most commonly presents with high activity in the crib, less sleep, and excessive crying.
What are the symptoms of ADHD
ADHD can have its onset in infancy but it is rarely diagnosed until the child is at least a toddler. In an infant, ADHD most commonly presents with high activity in the crib, less sleep, and excessive crying.
In school, children with ADHD may attack a test rapidly but may answer only the first two questions. They may be unable to wait to be called on in school and may respond before everyone else. At home, caregivers cannot put them off for even a minute. Children with ADHD are often susceptible to accidents.
The common symptoms can be broadly classified into the following on the basis of frequency:
- Hyperactivity:Keeps roaming around in class, disturbs other students
- Inattention:Inability to focus or poor concentration, making frequent mistakes, easily distracted, unable to finish tasks, short attention span
- Impulsivity:Unable to wait for their turn, answering before the question is complete, interfering in others' talks
- Other symptoms such as Destructive behavior, Irritability, Aggression, Memory and Thinking deficits, Specific Learning Disabilities, and Speech and Hearing deficits may also be present.
Diagnosis for ADHD
According to DSM-5, the symptoms should appear before the age of 12 (as opposed to the previous 7 years). DSM-5 has also replaced the previous two subtypes (Inattentive and Hyperactive/Impulsive) with the following 3 specifiers:
- Predominantly hyperactive/impulsive presentation
- Predominantly inattentive presentation
- Combined presentation
To confirm a diagnosis of ADHD - persistent, impairing symptoms of either hyperactivity/impulsivity or inattention interfering with social or academic functioning appropriate for the chronological and developmental age of the child should be observed in at least two different settings.
ADHD
Treatment
When children with ADHD reach puberty/adolescence, the symptoms, especially Hyperactivity and Impulsivity get better. Around 50% achieve remission by Puberty but the rest are vulnerable to Substance abuse disorders, Antisocial personality disorders, and Mood disorders like depression.
Pharmacotherapy is considered to be the first line of treatment for ADHD. CNS stimulants are the preferred group of drugs in children due to their high efficacy and milder side effects. They help to treat the under-stimulation of the brain which leads to compensatory hyperactivity.Methylphenidate is the drug of choice for ADHD in children but its efficacy is limited by the dose-related side effects. Newer preparations aim to maximize the target effects and minimize the side effects. Other stimulants that can be used are Dexmethylphenidate, Amphetamines, Modafinil, etc. Current strategies favor once-a-day sustained-release stimulant preparations for their convenience and diminished rebound side effects.
Children, adolescents, and adults with known cardiac risks and abnormalities should not use stimulants. Non-stimulant medications approved by the FDA in the treatment of ADHD include Atomoxetine, a norepinephrine uptake inhibitor, α-agonists like Clonidine and Guanfacine, and Anti-depressants such as Bupropion.
In addition to pharmacotherapy, Psychotherapy like Behavioral therapy (BT) and Cognitive Behavioral Therapy (CBT) is used. Apart from these, Social skills training and psychoeducation of the parents are also essential in the comprehensive treatment of ADHD
