General+Information

= = http://www.youtube.com/watch?v=irTf3CVt1tk  ADHD: General Information

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=Attention deficit hyperactivity disorder is a developmental disorder characterized by maladaptive levels of inattention, over activity and impulsivity. It is one of the common childhood disorders and can continue through adolescence and adulthood ("ADHD: The Diagnostic Criteria," 2001). Diagnostic Criteria = = = =DSM IV Criteria for Attention Deficit Hyperactivity Disorder: = =A) Either (1) or (2) = =1) Six or more of the following symptoms of **inattention **  have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level: =  **Inattention: **

("ADHD: The Diagnostic Criteria," 2001)
 *  Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
 * <span style="font-family: Georgia,serif; font-weight: normal;">Often has difficulty sustaining attention in tasks or play activities
 * <span style="font-family: Georgia,serif; font-weight: normal;">Often does not seem to listen when spoken to directly
 * <span style="font-family: Georgia,serif; font-weight: normal;">Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure of comprehension)
 * <span style="font-family: Georgia,serif; font-weight: normal;">Often has difficulty organizing tasks and activities
 * <span style="font-family: Georgia,serif; font-weight: normal;">Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
 * <span style="font-family: Georgia,serif; font-weight: normal;">Often loses things necessary for tasks or activities at school or at home (e.g. toys, pencils, books, assignments)
 * <span style="font-family: Georgia,serif; font-weight: normal;">Is often easily distracted by extraneous stimuli
 * <span style="font-family: Georgia,serif; font-weight: normal;">Is often forgetful in daily activities

=<span style="font-family: Georgia,serif; font-size: 12pt;">2) Six or more of the following symptoms of **<span style="font-family: Georgia,serif; font-size: 12pt;">hyperactivity-impulsivity ** <span style="font-family: Georgia,serif; font-size: 12pt;"> have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level: = <span style="font-family: Georgia,serif; font-size: 12pt; font-weight: normal;">Hyperactivity


 * often fidgets with hands or feet or squirms in seat
 * often leaves seat in classroom or in other situations in which remaining seated is expected
 * often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
 * often has difficulty playing or engaging in leisure activities quietly
 * often talks excessively
 * if often ‘on the go’ or often acts as if ‘driven by a motor’

<span style="font-family: Georgia,serif; font-size: 12pt; font-weight: normal;">Impulsivity

("ADHD: The Diagnostic Criteria," 2001) =<span style="font-family: Georgia,serif; font-size: 12pt;">B. Onset before the age of 7. = =<span style="font-family: Georgia,serif; font-size: 12pt;">C. Some impairment from the symptoms is present in more than two or more settings (e.g. at school or work or at home) = =<span style="font-family: Georgia,serif; font-size: 12pt;">D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning ("ADHD: The Diagnostic Criteria," 2001) = =<span style="font-family: Georgia,serif; font-size: 12pt;"> = = There are over __115,000__ different combinations of symptoms that can lead to a diagnosis of ADHD. This is calculated on the basis of every possible combination of the 9 inattention symptoms with every combination of 6 of 9 hyperactivity/impulsively symptoms and vice versa<span style="font-family: Georgia,serif; font-size: 12pt;"> = =<span style="font-family: Georgia,serif; font-size: 12pt;"> =
 * Often has difficulty awaiting turn in games or group situations
 * Often blurts out answers to questions before they have been completed
 * Often interrupts or intrudes on others, e.g. butts into other children’s games

media type="file" key="The ADHD Song.flv" width="360" height="270" <span style="display: block; font-family: Georgia,serif; font-size: 130%; text-align: left;">
 * Subtypes**

<span style="font-family: Georgia,serif; font-size: 12pt;">
 * < **<span style="font-family: Georgia,serif; font-size: 12pt;">Predominantly Hyperactive- Impulsive **

__Qualifiers__ Manifested By 6 or More Hyperactivity-Impulsivity Symptoms persisting at least 6 months

Inattention may be present to some degree || **<span style="font-family: Georgia,serif; font-size: 12pt;">Hyperactivity **
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often fidgets with hands or feet or squirms in seat
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often leaves seat in classroom or in other situations in which remaining seated is expected
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often runs about or climbs excessively in situations in which it is inappropriate
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">in adolescents or adults this may be limited to subjective feelings of restlessness
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often has difficult playing or engaging in leisure activities quietly
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often talks excessively
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often ‘on the go’ or acts as if ‘driven by a motor’

**<span style="font-family: Georgia,serif; font-size: 12pt;">Impulsivity ** <span style="font-family: Georgia,serif; font-size: 12pt;"> __Qualifiers__
 * <span style="font-family: Georgia,serif; font-size: 12pt;">often has difficulty awaiting turn in games or group situations
 * <span style="font-family: Georgia,serif; font-size: 12pt;">often blurts out answers to questions before they have been completed
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often interrupts or intrudes on others e.g. butts into other children’s games ||
 * < **<span style="font-family: Georgia,serif; font-size: 12pt;">Predominantly Inattentive **

As manifested by 6 or more symptoms of inattention that have persisted for at least 6 months OR fewer than 6 symptoms of hyperactivity-impulsivity are present Children have difficulties getting along with other children and are not paying attention to what they are doing || **<span style="font-family: Georgia,serif; font-size: 12pt;">Inattention ** <span style="font-family: Georgia,serif; font-size: 12pt;">__Qualifiers__
 * <span style="font-family: Georgia,serif; font-size: 12pt;">often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
 * <span style="font-family: Georgia,serif; font-size: 12pt;">often has difficulty sustain attention in tasks or play activities
 * <span style="font-family: Georgia,serif; font-size: 12pt;">often does not seem to listen when spoken to directly
 * <span style="font-family: Georgia,serif; font-size: 12pt;">often does not follow through on instructions and fails to finishes schoolwork, chores, or duties in the workplace
 * <span style="font-family: Georgia,serif; font-size: 12pt;">not due to oppositional defiant disorder or failure of comprehension
 * <span style="font-family: Georgia,serif; font-size: 16px; line-height: 24px;">often has difficulty organizing tasks ||
 * < **<span style="font-family: Georgia,serif; font-size: 12pt;">Combined Hyperactivity-Impulsive and Inattentive **

As manifested by 6 or more symptoms of inattention and hyperactivity-impulsivity

Most common type || <span style="background-color: #ffffff; display: block; font-family: Georgia,serif; font-size: 12pt; text-align: left;">* As listed above || ("ADHD: The Diagnostic Criteria," 2001)


 * ADHD is estimated to occur in 6% of school aged children.
 * ADHD is four times more common in boys than in girls.The reason for gender difference is unknown.
 * The research conducted by Herrero ,Hechtman and Weiss (1994) at the Montreal Children's hospital and McGill University declares that ADHD is a risk factor for antisocial outcomes only in boys.
 * Children with ADHD are usually first identified around age 3 or 4.
 * Some children grow out of ADHD; 68% of children continue to experience problems through adulthood.(Durand //et al.,// 2008)
 * Research shows that adults with ADHD have more driving difficulties such as crashes,speeding,and suspension of their licenses. (Durand //et al.,// 2008)
 * <span style="font-family: Georgia,serif;">World-wide improvements in diagnosis brought ADHD children to the attention of helping professionals.

<span style="display: block; font-family: Georgia,serif; font-size: 16pt; text-align: center;">**Etiology** <span style="display: block; font-family: Georgia,serif; font-size: 12pt; text-align: left;">A specific cause of ADHD is not known, however there are a number of factors that MAY contribute to the disorder including:


 * __1. Genetic Factors__ **
 * Biological parents of children with the disorder have a higher incidence of ADHD
 * There is greater concordance in identical twins than in fraternal twins.
 * Siblings of hyperactive children have about twice the risk of having the disorder as does the general population
 * Researchers are looking at several genes that may make people more chance to develop ADHD. People with ADHD carry certain genes and transmitted to other generation. There is strong evidence that ADHD is associated with the Dopamine D4 receptor gene,the transporter gene,and the dopamine D5 receptor gene.
 * The volume of brain is smaller in children with ADHD .The main areas of the brain appear smaller than is typical-frontal cortex(outer portion of the brain),basal ganglia(deep within the brain),cerebellar vermis (part of the cerebellum in the back of the brain) (Durand //et al.,// 2008).It occurs early in the development of brain and no progressive brain damage in individuals.

<span style="font-family: Georgia,serif; font-size: 12pt;">**__2. Biochemical Theory:__** Studies have shown decreased blood flow in the frontal areas of children with ADHD.When concentrate on a task, adults with ADHD have reduced brain glucose metabolism in the frontal lobe of brain, compared to non-ADHD individual. This pattern of under activity is due to abnormalities in the neurotransmitters in the frontal areas. (Greenberg, n.d.). A deficit of dopamine and nor epinephrine has been attributed in the over activity seen in ADHD. This deficit of neurotransmitters is believed to lower the threshold for stimuli input. <span style="font-family: Georgia,serif; font-size: 12pt;">__**3. Pregnancy Related Factors:**__ <span style="font-family: Georgia,serif; font-size: 12pt;">**__4. Environmental Influences:__** <span style="font-family: Georgia,serif; font-size: 12pt;">**__5. Psychosocial factors:__**
 * Prenatal toxic exposure (maternal smoking, drugs and alcohol abuse during pregnancy), prenatal mechanical insult to the fetal nervous system.Maternal smoking during pregnancy may be up to 3 times more chance to have a child with ADHD than non smoking mothers.
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Prematurity, fetal distress precipitated or prolonged labor, perinatal asphyxia, and low Apgar scores.
 * Postnatal infections, CNS abnormalities resulting from trauma
 * Preschoolers who exposed to high amount of environmental lead.
 * Recent British research indicates the possible link between consumption of certain food additives like artificial colors, dyes or preservatives and hyperactivity ("Attention Deficit Hyperactivity Disorder (ADHD)," 2009).
 * Sugars have also been suggested as possible causes of hyperactive behavior but there is no definite evidence.
 * Prolonged emotional deprivation
 * Stressful psychic events
 * Disruption of family equilibrium (Sreevani,2004)
 * <span style="font-family: Georgia,serif; font-size: 110%;">Research by University of British Columbia clinical psychologist Charlotte Johnston and her colleagues suggests that problems with peers and frequent negative feed back from parents and teachers result in low self -esteem,negative self -image,and negative impact on their ability to make friends.In most cases children with ADHD are unpopular and rejected by their peers (Durand //et al.,// 2008).

<span style="display: block; font-family: Georgia,serif; font-size: 120%; text-align: center;"> <span style="display: block; font-family: Georgia,serif; font-size: 144%; text-align: center;">**Risk Factors** <span style="font-family: Georgia,serif;">Risk factors for ADHD are:


 * Male sex
 * <span style="font-family: Georgia,serif;">Parent or sibling with ADHD.

<span style="font-family: Georgia,serif; font-size: 120%;"> <span style="display: block; font-family: Georgia,serif; font-size: 144%; text-align: center;">**Associated Disorders** <span style="display: block; font-family: Georgia,serif; font-size: 120%; text-align: center;"> : <span style="font-family: Georgia,serif;">People with ADHD can also have:
 * <span style="font-family: Georgia,serif;">Depression
 * <span style="font-family: Georgia,serif;">anxiety
 * <span style="font-family: Georgia,serif;">Conduct Disorder
 * <span style="font-family: Georgia,serif;">Learning disorders
 * <span style="font-family: Georgia,serif;">substance abuse
 * <span style="font-family: Georgia,serif;">oppositional defiant disorder.(Julie Riley,2009)