Attention Deficit Hyperactivity Disorder (ADHD)

What is Attention Deficit Hyperactivity Disorder (ADHD)?

Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioural disorder affecting children.
It may present in infancy and can continue into adulthood.
It affects 5-8% of children and nearly three times as many boys as girls.
Nearly half the children presenting with ADHD may also have an associated learning problem.
The term is commonly applied wrongly to the normal child who is always on the go and never sits still.
Recognized causes of hyperactivity in children include normal variation, boredom or understimulation or excessive restraint, learning difficulties, autism, partial seizures and drugs like clonazepam, phenobarbitone and phenytoin.
ADHD is also wrongly attributed to poor parenting, too much TV, poor schools, poor home environment, excess sugar or food allergies.
No specific tests confirm a diagnosis of ADHD.
A full physical and neurological examination must be done in all cases.
The behavioural deficits and excesses that constitute a diagnosis of ADHD must be present in multiple settings such as home and school.

Causes of Attention Deficit Hyperactivity Disorder (ADHD)

The causes is unknown
Related factors:

  • Hereditary
  • Imbalance of neurotransmitters

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD)

1. Inattention

  • child often fails to finish things he or she starts
  • often does not seem to listen
  • has difficulty concentrating on school work

2. Impulsivity

  • child often acts before thinking
  • hits others when upset
  • inability to wait for his or her turn in a game
  • engages in dangerous activities without consideration of the consequences
  • has difficulty organizing work (this not due to cognitive impair ment)

3. Hyperactivity

  • child tries to do several things at once
  • talks incessantly,
  • struggles to sit still at a desk and fidgets

4. Distractibility

  • evidenced by not listening when spoken to
  • an inclination to daydream
  • not being able to work independently
  • disorganized

Signs of Attention Deficit Hyperactivity Disorder (ADHD)

  • Similar to symptoms above

Investigations

  • Usually none

Treatment for Attention Deficit Hyperactivity Disorder (ADHD)

Objectives

The treatment objectives of ADHD are

  1. To reduce hyperactivity
  2. To improve attention
  3. To improve compliance to instruction

Non-pharmacological treatment

Behaviour management techniques –

Evidence Rating: [A]

  • A class helper in class to sit with child and focus attention to school work
  • Parenting class to help parents cope
  • Desist from punitive physical interventions e.g. caning

Pharmacological treatment

1st Line Treatment
Evidence Rating: [A]
Methylphenidate, oral,
Adults: 10 mg 8-12 hourly (max. 60 mg)

Then

Increase weekly by 5-10 mg, if necessary, to max. of 30 mg 12 hourly
Children

  • 6-18 years; 2.5-5 mg 12 hourly. Increase weekly by 5-10 mg, if necessary, to max. of 30 mg 12 hourly
  • 4-6 years; 2.5 mg 12 hourly Increase weekly by 2.5 mg daily to max. of 1.4 mg/kg if necessary in 2 to 3 divided doses.
  • <4 years; not recommended

Or

Atomoxetine, oral,
Adults: 40 mg once daily for 7 days

Then

  • Increase according to response to a max. of 100 mg

Children

  • > 6 years (weight > 70 kg); 40 mg once daily for 7days. Then Increase according to response to a max. of 80 mg
  • > 6 years (weight < 70 kg); 500 micrograms/kg daily for 7 days. Then Increase according to response to a max. of 1.2 mg/kg daily
  • < 6 years; not recommended.

2nd Line Treatment
Evidence Rating: [B]
Imipramine, oral,
Adults: 75 mg daily. Then increase to 150 mg daily if necessary (max. 200 mg per day)
Children: 6-18 years; 10-30 mg 12 hourly

Referral Criteria

Refer to a clinical psychologist for behaviour management.
An occupational therapist, remedial teacher, speech therapist following a needs assessment.
Refer to a specialist if there is no clinical improvement after a month of the above recommended therapy.