Basics of ADHD

1. Ajay Nihalani
MD,MRCPsych

2. Hyperkinetic Disorder
Minimal Brain Damage
Minimal Brain Dysfuntion
Strauss Syndrome
Heinrich Hoff 1854

3. Incidence & Prevalence
Affects 3-6 % school aged children
7 times more commoner in boys
Manifests by 7 yrs age,In majority by age
4.

4. Types of ADD
1)ADD with Hyperactivity
2) ADD WITHOUT Hyperactivity
3) Residual Type
4) ADD with Conduct Disorder

5. ADD with Hyperactivity(Hyperkinetic disorder)
Commonest type
Poor attention span with distractibility
Hyperactivity
Impulsivity

6. Poor Attention Span With Distractibility
1)Fails to finish things started
2) Shifts from one unfinished activity to another
3) Doesn't seem to listen
4)Easily distracted by external stimuli
5)Often loses things

7. Hyperactivity
1)Fidgety
2)Difficulty is sitting still at one place
3)Moving about here and there
4)Talks excessively
5)Interferes in other peoples activities

8. Impulsivity
1)Acts before thinking,On the spur of the moment
2)Difficulty in waiting for turn at work or
play

9. Attention Deficit disorder without
hyperactivity
Residual Type….In Adults
Hyperkinetic disorder with
Conduct Disorder

10. Diagnosis
Parent,Teacher Reports&
Clinical Examination

11. Etiology
Multifactorial
Minimal brain damage
Genetics
Neurotransmitters

12. Course
80% improve in puberty
20% persist in Adulthood

13. Conduct Disorder
Persistent & Significant pattern of conduct
characterized by violation of the rights of others
Inability to follow rules of society
Conduct disorder confined to the famiy context
Unsocialised conduct disorder
Socialised conduct disorder
Oppositional defiant disorder

14. Clinical features
Frequent lying
Stealing
Truancy
Physical violence
Cruelty towards people or animals
Secondary Complications
Substance misuse,unwanted pregnancies,criminal
record,suicidal &homicidal behavior.

15. Treatment
Stimulants
Methylphenidate,Dexamphetamine
Nonstimulants
Atomoxetine,Imipramine,Bupropion,Clonidine,Risperidone
Barbiturates worsen hyperactivity.
Behaviour modification,Counselling.
MTAS Study