Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that interferes with functioning or development.
Causes
- Genetic Factors: ADHD tends to run in families, suggesting a genetic component.
- Brain Structure and Function: Differences in certain brain areas, neurotransmitter systems (dopamine and norepinephrine), and reduced activity in parts of the brain that control attention and activity levels.
- Prenatal Exposures: Smoking, alcohol use, and drug use during pregnancy have been associated with an increased risk of ADHD in offspring.
- Environmental Factors: Exposure to environmental toxins, such as lead, especially at a young age, may be linked to ADHD.
- Premature Birth: Being born prematurely or with a low birth weight.
Diagnosis
- History
- Symptom Onset: Symptoms usually appear before age 12, often around age 3-7.
- Inattention: Difficulty sustaining attention, disorganization, forgetfulness, easily distracted.
- Hyperactivity and Impulsivity: Fidgeting, excessive talking, restlessness, interrupting, acting without thinking.
- Impact on Functioning: Symptoms must be present in two or more settings (e.g., at home, school, or work) and interfere with or reduce the quality of social, school, or work functioning.
- Physical Examination
- General Physical Exam: To rule out other medical conditions that might cause similar symptoms.
- Neurological Exam: Although not always included, it might be considered to rule out other neurological conditions.
- Investigations
- Rating Scales and Checklists: Standardized tools completed by caregivers, teachers, and sometimes the patient.
- Psychological Evaluation: To assess for learning disabilities, mood disorders, and behavior problems.
- Developmental and Educational Assessments: Evaluating the child’s developmental level and academic achievement.
Differential Diagnosis (DDx)
- Learning Disabilities
- Mood Disorders (e.g., Depression, Bipolar Disorder)
- Anxiety Disorders
- Behavioral Disorders (e.g., Oppositional Defiant Disorder, Conduct Disorder)
- Autism Spectrum Disorder
- Sleep Disorders
Management
- Non-Pharmacological
- Behavioral Therapy: Especially effective in younger children. Can include parent training in behavior management, behavior modification strategies in the classroom, and social skills training.
- Psychoeducation: Educating the child and family about ADHD and how it affects learning and behavior.
- School-Based Programs: Including individualized education programs
- Pharmacological
- Stimulants: Such as methylphenidate and dexamphetamine. First-line treatment in children older than 6 years and adults.
- Non-Stimulants: Such as atomoxetine, guanfacine, and clonidine. May be used when stimulants are ineffective or cause intolerable side effects.
Monitoring and Follow-up
- Regular follow-up to monitor effectiveness and side effects of medication.
- Behavioral and academic progress monitoring.
Referral
Referral to a paediatrician or psychiatrist is required for diagnosis and treatment. Once a diagnosis is established GPs can become a nominated co-prescriber.
Patient and Family Education
- Education about the nature of ADHD, treatment options, and management strategies.
- Importance of a structured environment and consistent routines.
The approach to ADHD is often multi-faceted, involving educational interventions, behavioral strategies, and medication. The management plan should be tailored to the individual’s symptoms and needs, with close monitoring and adjustment as needed.