This document provides an overview of attention deficit hyperactivity disorder (ADHD). It begins with an introduction that describes ADHD as a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It then discusses the types of ADHD (predominantly inattentive, predominantly hyperactive-impulsive, and combined type), prevalence rates, etiology, comorbidities, signs and symptoms, diagnosis, prognosis, and treatment options. Treatment involves medication, therapy like cognitive behavioral therapy, behavior therapy, and lifestyle modifications to help manage symptoms.

1. Sit Dolor Amet
Presented by,
Subhangini Mallick &
Sayantani Kar

2.  INTRODUCTION
 TYPES
 PREVALENCE
 ETIOLOGY
 COMORBIDITIES
SIGNS AND SYMPTOMS
 DIFFERENTIAL DIAGNOSIS
 PROGNOSIS
 TREATMENT
 CONCLUSION

3.  ADHD is one of the most common neurodevelopmental disorders of
childhood. It is usually first diagnosed in childhood and often lasts into
adulthood. Children with ADHD may have trouble paying attention,
controlling impulsive behaviors (may act without thinking about what the
result will be), or be overly active.
 In children, problems paying attention may result in
poor school performance .
 People with ADHD struggle to focus on tasks they are not
particularly interested in completing, they are often able to
maintain an unusually prolonged and intense level of attention
for tasks they do find interesting or rewarding; this is known
as hyperfocus.
Introduction

4. •Formerly known as ADD, Inattentive Type ADHD is characterized by a
lack of attention and distractibility with no signs of hyperactive
behavior. The child staring out the classroom window—seemingly
daydreaming—instead of paying attention to the lesson.
•People with this type of ADHD have weak working memory and
frequently lose things. Adult and girls are more commonly diagnosed
with this type
PREDOMINATELY INATTENTION
•This type of ADHD is marked by hyperactive and impulsive behavior
with no inattentive behavior . They interrupt others and seem to talk
constantly. At school, they may blurt out answers and struggle with
self-control. Young boys are typically diagnosed with this type
PREDOMINATELY HYPERACTIVE-
IMPULSIVE
•ADHD that presents as a mix of both hyperactive-impulsive behaviors
and inattentive-distracted behavior.
COMBINED TYPE

5. In India, a study entitled Prevalence of Attention Deficit Hyperactivity Disorder in Primary
School Children that was conducted in Coimbatore found ADHD prevalence in children to
be higher than the global estimate, at 11.32%. The highest prevalence is found in ages 9
(at 26.4%) and 10 (at 25%). 7.4% globally affected
The study showed that more males (66.7%) were found to have ADHD than females .
The estimated prevalence of ADHD in school-aged children increased from 6% in 1997 to
9% in 2006
[ National Center for Health Statistics, 2006]
9.4% of children and 4% of adult in America are likely to have ADHD [Kessler et al. 2006].

6.  The prevalence of ADHD presentations varies with age,
according to preliminary evidence from a cross-sectional
meta-analysis of 97 studies (n=175,800).

7. Neuro-chemical
Factors
Genetic
Factors
Causes of
ADHD
Neuro-
Anatomical
Factors
Developmental
Factors
Psychological
factors

8.  Family Studies have shown that 25% closer relatives in the families of ADHD children
have ADHD compared to 5% of general populations.
1/3 of ADHD children have at least one parent who has ADHD.
Twin studies have shown that there is up to 75% increased concordance in
monozygotic twins to develop ADHD as compared to dizygotic twins .
DA Transporter Gene [DAT1]
Dopamine receptor [DRD4, “ Repeater Gene”] is over represented in ADHD patients
Some genetic syndromes like Fragile-X Syndrome , Tuberous Sclerosis etc , can cause
ADHD.

9.  There are two main neurotransmitters involved in ADHD:
1] Dopamine and 2]Norepinephrine 3]Serotonine
 These neurochemicals have been shown to be involved in impulsive control,
prioritization, focus, decision-making, frustration tolerance, and time management,
among many other important mental processes. The brains of people diagnosed
with ADHD show a deficit in these two key neurotransmitters
 Dopamine (DA) is a neurochemical that is considered to be directly linked with our
perception of pleasure and reward. People with ADHD have been observed to have
more dopamine transporters in the brain, which cause less dopamine to be
available.
 Norepinephrine (NE) is another neurochemical that is related to dopamine and is
found in lower-than-normal levels in ADHD brains Norepinephrine is involved in
focus, processing, and controlling impulsive behaviors

11.  The ADHD brain has impaired activity in four functional
regions of the brain.
1] Frontal cortex,
2]Basal ganglia ,3] Limbic system , 4] Reticular activating
system
 Reduction in volume and activity of caudate nucleus,
prefrontal cortex white matter , corpus callosum and
cerebellar vermis
 Reduction in Globus pallidus and ventral striatum.
 Reduction in temporal and superior cortices

13.  Parents who smokes and drink alcohol during pregnancy are more
likely to have children with ADHD.
 Being exposed to certain environmental toxins during childhood can
increase the risk that a child will develop ADHD. Exposure to lead (even
low levels) can result in hyperactivity and inattention. Lead can be found
a variety of places, such as in the paint of homes built before 1978 or
previously in gasoline.
 Premature birth , Maternal gestational bleeding , gestational diabetes
and maternal infection.
 Perinatal insult to the brain during early infancy caused by trauma ,
inflammation , fetal distress , low birth weight.
 Dietary constituents that have been studied in relation to ADHD
symptoms include sugar, artificial food colourings , zinc, iron,
magnesium and omega-3 fatty acids. There is no convincing evidence
yet that diet plays a major causal role in ADHD

14.  Adverse social and family environments such as low
parental education, social class, poverty, bullying/peer
victimization , negative parenting, maltreatment and
family discord are associated with ADHD.
 Negative mother/son and peer relationships arise in
response to child ADHD symptoms. This contrasts
with findings for child antisocial behaviour/conduct
disorder in which a variety of designs including
treatment trials have consistently found that adverse
social and family environments are causal.

15. OPPOSITIONAL
DEFIANT
DISORDER
[21% to 60% ]
TOURETT’S
SYNDROME
[55%]
ANXIETY
[Approximately
25% ]
LEARNING
DISORDER
[9% vs 4%,]
CONDUCT
DISORDER
[25% to 40% ]
DEPRESSION
[0 to 30%]
 Comorbid conditions are distinct
diagnoses that exist simultaneously with
ADHD.
 In general, individuals affected by ADHD
often have other behaviour disorders that
impact their ability to function
successfully.
 The comorbidity of ADHD with other
disorders
is between 60% and 80%.
 When comorbid conditions are present, it
can make the diagnosis of ADHD much
more difficult to pinpoint and the
symptoms harder to treat.
 Some comorbid disorders that commonly
occur alongside ADHD are:
ADHD

16. In children or toddlers with ADHD, this can lead
to symptomsTrusted Source at home, in day care, or
at school, such as:
 trouble focusing on activities and becoming easily
distracted
 low attention span while playing or doing
schoolwork
 fidgeting, squirming, or otherwise having trouble
sitting still
 constantly needing movement or frequently running
around
 engaging in activities loudly or disruptively
 excess talking and interrupting other people

17. ADD ADHD
ADD is an acronym for Attention
Deficit
Disorder.
ADHD is an acronym for Attention Deficit Hyperactivity Disorder
Now referred to as ADHD,
Predominantly
Inattentive Type.
Has 3 sub-types: inattentive ADHD, hyperactive- impulsive ADHD & their combination.
Not characterised by hyperactivity. Characterised by hyperactivity.
Child may appear shy, reserved and
calm.
Child will be highly energetic and
active.

18.  There really is no cure for ADHD. Most children with this condition continue with its symptoms
into adulthood.
 80% of the children who require medication for ADHD will need them as teenagers. Over 50%
need medication as adults.
 MEDICATION-
There are 5 types of medicine licensed for the treatment of ADHD :
 Methylphenidate
 Dexamfetamine
 Lisdexamfetamine
 Atomoxetine
 Guanfacine
 THERAPY- As well as taking medicine, different therapies can be useful in treating ADHD in
children, teenagers and adults. Therapy is also effective in treating additional problems, such as
conduct or anxiety disorder, that may appear with ADHD.
 Here are some of the therapies that may be used -

19.  PSYCHOEDUCATION - It means you or your child will be encouraged to discuss ADHD
and its effects. It can help children, teenagers and adults make sense of being diagnosed with
ADHD, and can help you to cope and live with the condition.
 BEHAVIOUR THERAPY - It usually involves behaviour management, which uses a
system of rewards to encourage your child to try to control their ADHD.
If your child has ADHD, you can identify types of behaviour you want to encourage, such as
sitting at the table to eat. Your child is then given some sort of small reward for good behaviour
 PARENT TRAINING AND EDUCATION PROGRAMMES - If your child has ADHD,
parent training and education programmes can help you learn specific ways of talking to your child, and
playing and working with them to improve their attention and behaviour.
 SOCIAL SKILLS TRAINING -
Social skills training involves your child taking part in role-play situations and aims to teach them how to
behave in social situations by learning how their behaviour affects others.
 COGNITIVE BEHAVIOURAL THERAPY (CBT) -
CBT is a talking therapy that can help you manage your problems by changing the way you think and
behave. A therapist would try to change how you or your child feels about a situation, which would in turn
potentially change their behaviour.

20.  The following are suggestions that may help with child’s behaviour :
 Create a routine.
 Parents should try to follow the same schedule every day,
from wake-up time to bedtime.
 Get organised.
 They should encourage their child to put school bags,
clothing, and toys in the same place every day so that they
will be less likely to lose them.
 Manage distractions.
 Turn off the TV, limit noise, and provide a clean workspace
when child is doing homework.
 Some children with ADHD learn well if they are moving or
listening to background music. [Parent should Watch their
child and see what works.
 Limit choices.
 To help the child not feel overwhelmed or overstimulated, offer
choices with only a few options.
 For example, have them choose between this outfit or that
one, this meal or that one, or this toy or that one.

21.  Help your child plan.
 Break down complicated tasks into simpler, shorter steps. For long
tasks, starting early and taking breaks may help limit stress.
 Use goals and praise or other rewards.
 Use a chart to list goals and track positive behaviours , then let the
child know they have done well by telling them or by rewarding their
efforts in other ways. Be sure the goals are realistic—small steps are
important!
 Discipline effectively.
 Instead of scolding, yelling, or spanking, use effective directions, time-
outs or removal of privileges as consequences for inappropriate
behavior .
 Create positive opportunities.
 Children with ADHD may find certain situations stressful. Finding out
and encouraging what child does well—whether it’s school, sports, art,
music, or play—can help create positive experiences.
 Provide a healthy lifestyle.
 Nutritious food, lots of physical activity, and sufficient sleep are
important; they can help keep ADHD symptoms from getting worse.

22. ADHD-a condition that can cause trouble with focus , patient
and over- activity . Most common childhood disorder.
Three types of ADHD – Inattention , Hyperactive-Impulsive
Combined.
Boys are more likely to have ADHD than girls.
So many causes can result ADHD like genetic factors
neurotransmitters
[ dopamine and norepinephrine] , some environmental
psychological , anatomical Factors.
ADHD can’t be cured , but can be managed . In most cases
ADHD is best treated with a combination on medication an
behaviour therapy .
 Parents has very important role in treating child with ADHD
They need to build a positive relationship with more efforts tha
general population. They need to understand their child .

23. www.verywellmind.com
Kaplan and Saddock’s [Book of Psychiatry]
www.webmd.com
www.healthline.com.
Niraj Ahuja [A Short Book O F Psychiatry]