Attention deficit hyperactivity disorder
The patient with attention deficit hyperactivity disorder (ADHD) has difficulty focusing his attention; engaging in quiet, passive activities; or both. Although the disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child shows severe symptoms. In some cases, however, the patient isn’t diagnosed until adulthood.
Causes and incidence
ADHD is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from disturbances in neurotransmitter levels in the brain due to reduced blood flow in the striated area of the brain. It affects 3% to 5% of school-age children and is three times more common in boys than in girls.
Signs and symptoms
The principal sign of ADHD is hyperactivity that’s present over a long period, in at least two settings (such as school and home), and is accompanied by easy distractibility. The patient may be impulsive, emotionally labile, explosive, or irritable. Although he may be highly intelligent, his school or work performance patterns are sporadic. He may jump from one partly completed project, thought, or task to another. The patient may have an attention deficit without hyperactivity; if so, he’s less likely to be diagnosed and treated.
In a younger child, signs and symptoms include an inability to wait in line, remain seated, wait his turn, or concentrate on one activity until its completion. An older child or an adult may be described as impulsive and easily distracted by irrelevant thoughts, sounds, or sights. He may also be characterized as emotionally labile, inattentive, or prone to daydreaming. His disorganization becomes apparent as he has difficulty meeting deadlines and keeping track of school or work tools and materials.
Diagnosis
The child is usually referred for evaluation by the school. (See Diagnosing attention deficit hyperactivity disorder.) Diagnosis of ADHD usually begins by obtaining data from several sources, including the parents, teachers, and the child himself. Complete psychological, medical, and neurologic evaluations rule out other problems. Then the child undergoes tests that measure impulsiveness, attention, and the ability to sustain a task. The combined findings portray a clear picture of the disorder and of the areas of support the child will need.
Treatment
Education is the first step in effective treatment. The entire treatment team (which ideally includes parents, teachers, and therapists as well as the patient and the physician) must understand the disorder and its effect on the individual’s functioning.
Treatment varies, depending on the severity of symptoms and their effects on the child’s ability to function. Behavior modification, coaching, external structure, use of planning and organizing systems, and supportive psychotherapy help the patient cope with the disorder.
The patient may benefit from medication to relieve symptoms. Ideally, the treatment team identifies the symptoms to be managed, selects appropriate medication, and then tracks the patient’s symptoms carefully to determine the drug’s effectiveness. Stimulants are the most commonly used agents. Antipsychotics may sometimes be used in combination with stimulants. However, other drugs, including tricyclic antidepressants, mood stabilizers, and beta-adrenergic blockers, sometimes help control symptoms.
Special considerations
❑ Work with the individual to develop external structure and controls.
❑ Set realistic expectations and limits because the patient with ADHD is easily frustrated (which leads to decreased self-control).
❑ Remain calm and consistent.
❑ Keep instructions short and simple.
❑ Provide praise, rewards, and positive feedback whenever possible.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
Other Book Chapters Related to Hyperactivity
Read excerpts from these other book chapters related to Hyperactivity:
Medical Books Excerpts
- Agitation
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Agitation
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Agitation
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Agitation
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Hyperactivity
» Next page: Agitation (Professional Guide to Signs & Symptoms (Fifth Edition))
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