1) Attention deficit hyperactivity disorder (ADHD) is a brain disorder characterized by inattention, hyperactivity, and impulsivity that interferes with functioning. 2) While the specific causes are unknown, genetic and environmental factors like smoking during pregnancy may play a role. ADHD is associated with lower dopamine levels in the brain. 3) Diagnosis involves evaluating symptoms like poor attention, hyperactivity, and impulsivity based on reports from parents and teachers. Stimulant medications and behavioral therapy are commonly used to treat ADHD.

1. ATTENTION DEFICIT HYPERKINETIC
DISORDER
Suraj Honakamble,
Intern, MIMS Mandya.
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2. Contents
• Introduction
• Definition
• Aetiology
• Pathophysiology
• Types and Diagnostic criteria
• Diagnosis
• Course
• Treatment
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3. Introduction
• This is a syndrome first described by Heinrich Hoff in 1854.
Since then, it has been known by a variety of names such as
minimal brain dysfunction (MBD),hyperkinetic syndrome,
Strauss syndrome, organic drivenness and minimal brain
damage
• It occurs in about 3% of school age children.
• Males are 6-8 times more often affected.
• The onset occurs before the age of 7 years and a large
majority of patients exhibit symptoms by the 4th year of age.
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4. Definition
• Attention-deficit/hyperactivity disorder (ADHD) is a brain
disorder marked by an on-going pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning or
development.
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5. Aetiology
 Specific cause is unknown
 Some studies showed that 75% of ADHD cases are genetically
inherited
 Some studies also suggested that 9-20% is also due to
environmental factors
 Pregnancy: smoking, alcohol, and premature birth
 Diet: food additive such as artificial food coloring and
preservative significantly affects children with ADHD
 Low birth weight
 Brain injuries
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6. Pathophysiology
• Dopamine: research study suggests that various genes affect
the neurotransmitter dopamine:
– Dopamine activation is a reward for the brain
– ADHD individuals dopamine receptors are not as efficient
as a normal person’s therefore they have a lower
dopamine level
• Delayed in frontal and temporal lobe
• Accelerated maturity of the motor cortex
• SPECT shows reduce circulation
• Pet Scan shows a decrease glucose metabolism during activity
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7. Types and Diagnostic Criteria
1) Attention deficit disorder with hyperactivity:
DSM -5 Diagnostic criteria:
1. Poor attention span and distractibility
2. hyperactivity
3. Impulsivity
2) Attention deficit disorder without hyperactivity: It is
a rare disorder with similar clinical features, except
hyperactivity.
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8. 3) Residual type: It is usually diagnosed in a patient in
adulthood, with a past history of ADHD and presence of a
few residual features in adult life
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9. DSM-5, Diagnostic criteria
1) Poor attention span and distractibility:
• Easily distracted
• Miss details
• Forget things
• Frequently switch from one activity to another
• Difficulty focusing on one thing
• Becomes bored easily
• Difficult to focus attention on organizing & completing a task
or learning something new
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10. • Trouble completing or turning in homework assignments
• Often loses things needed to complete tasks or activities
• Doesn’t seem to listen when spoken to
• Daydreams
• Becomes easily confused, and moves slowly
• Difficulty processing information as quickly & accurately as
others
• Struggles to follow instructions
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11. 2) Hyperactivity:
• Fidgets and squirms in their seats
• Talks nonstop
• Dashes around, touching or playing with anything &
everything in sight
• Trouble sitting still during dinner, school, and story time
• Constantly in motion
• Difficulty doing quiet tasks or activities
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12. 3) Impulsivity:
• Very impatient
• Blurts out inappropriate comments
• Shows emotions without restraint
• Acts without regard for consequences
• Difficulty waiting for things they want or waiting their turns in
games
• Often interrupts conversations or others activities
• May often come off as aggressive or unruly.
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13. Diagnosis
1. Teacher’s school report (often the most reliable).
2. Parent’s report.
3. Clinical examination (many children with hyperactivity
may be able to sit still in the new setting of the hospital and
thus the diagnosis may be missed).
• Hyperactivity is also a common clinical symptom in mental
retardation. Thus, mental retardation should always be
excluded, before making a diagnosis of ADHD.
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14. Course
• A large majority (about 80%) of patients improve on their own
by the time of puberty, though a few (15-20%) may have
persistent symptoms even in adulthood.
• Impulsivity and inattention are usually the most common
residual features after puberty while hyperactivity often tends
to remit.
• ADD can also present in adulthood and Adult. Which continue
to have symptoms in adulthood and those who begin with
symptoms for the first time in adulthood.
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15. Tretment
• Pharmacotherapy:
1) Stimulant medication: Dextro-amphetamine or
dexamphetamine (2.5-20 mg/day) and methylphenidate
(5-60 mg/day) have been traditionally used. Currently,
Methylphenidate is the drug of choice in the treatment of
ADD, with a high response rate.
 Methylphenidate is also available in sustained release
formulations which are preferable due to improved treatment
concordance and convenience of once a day dose.
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16.  Both dexamphetamine and methylphenidate act on the
reticular activating system, causing stimulation of the
inhibitory influences on the cerebral cortex, thus decreasing
hyperactivity and/or distractibility.
• Atomoxetine, a norepinephrine reuptake inhibitor,may be an
alternative for children who do not respond to stimulants. The
usual dose range is 0.5-1.2 mg/kg/day.
• Atomoxetine appears to be the drug of choice in adult ADD.
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17. 2) Others: When stimulant medication is not available or is
not effective, other drugs can be used after careful
individual consideration of the risks and benefits in the
individual patient.
 These include clonidine, tricyclic antidepressants (such as
imipramine), bupropion, venlafaxine, chlorpromazine,
thioridazine, and lithium carbonate
 Barbiturates are contraindicated in ADHD
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18. • Behavioural therapy:
 Goal: change/monitor child behaviors
 Intervention includes:
 practical assistance with organizing tasks or completing
schoolwork, or working through emotionally difficult events
 allow child to give oneself praise or rewards for acting in a
desired way
 Parents and teachers also can give positive or negative
feedback for certain behaviors.
 Set clear rules, chore lists, and other structured routines can
help a child control his or her behavior
 Therapists may also teach children social skills, such as how
to wait their turn, share toys, ask for help, or respond to
teasing.
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19.  Cognitive behavioral therapy can also teach a person
mindfulness techniques, or meditation.
 The therapist also encourages the person with ADHD to adjust
to the life changes that come with treatment, such as thinking
before acting, or resisting the urge to take unnecessary risks.
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Thank You