Attention-deficit Hyperactivity disorder

 Epidemiology of ADHD.  Picture and Manifestation of disease.  Diagnostic criteria.  Management.

A 9-year-old boy’s mother has been called to school because her son has not been doing his homework. He claims he did not know about the assignments. He inturrupts other kids during class and according to the teacher, “never sits still.” Think: Attention deficit hyperactivity disorder (ADHD).

 Inattention  Hyperactivity  Impulsivity

 3 to 5% prevalence in school-age children  Three to five times more common in boys  Increased incidence of comorbid mood disorders, personality disorders, conduct disorder.  Most cases remit in adolescence; 20% of patients have symptoms into adulthood.

 Over activity in more than one situation; constant movement with inability to settle.  Diminished attention and concentration.  Impulsivity.  Excitability.  Excessive talking.  Interfering and intruding on others.  Recklessness; prone to accidents.  Disobedience and aggression.  Learning difficulties.

These criteria are present before age 12 These criteria are present in 2 or more setting Interfere with social, academic or occupational functioning

1. Establish diagnosis 2. Psycho-education to family 3. Psycho-education to school teacher 4. Behavior modification 5. Drug treatment

 Pharmacotherapy: CNS stimulants—methylphenidate (Ritalin) is first-line therapy, dextroamphetamine (Dexedrine), and pemoline (Cylert) SSRIs/tricyclic antidepressants (TCAs)—adjunctive therapy

 Individual psychotherapy—with focus on behavior modification techniques  Parental counseling (education and parenting skills training)  Group therapy—to help patient improve social skills, self-esteem, etc.

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 ADHD is common child psychiatric dis.  Over activity in more than one situation is very important manifestation of ADHD.  The disorders may affect attention or hyperactivity or both.  education and parenting skills training is very important and effective part of management. Please DO NOT FORGET ! Family and school teachers Psycho-education

 Basic Psychiatry (Prof. Mohammed Alsughayir)  First Aid Psychiatry clerkship