This document summarizes Attention Deficit Hyperactivity Disorder (ADHD) including its diagnosis and treatment options. It discusses how ADHD is diagnosed according to the DSM-5 criteria which requires 6 or more symptoms of inattention and/or hyperactivity-impulsivity. Differential diagnoses that should be considered include hearing/vision issues, lead poisoning, hyperthyroidism, etc. Treatment options include behavioral therapy, pharmacological therapy with stimulants or non-stimulants, and combination therapy. Behavioral therapy is generally recommended for preschoolers while medication plus therapy is suggested for school-aged children.

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Tutor Group 3:
Attention Deficit
Hyperactivity Disorder
Abdullatiff Sami AL-Rashed
Block 3.4
College of Medicine, King
Faisal University
Al-Ahsa, Saudi Arabia

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Objectives
- The case
- Introduction
- In terms of Differential Diagnosis, which somatic
causes of ADHD-like symptoms should be
considered/ruled out?
- How is ADHD diagnosed ?
- Which treatment options are available for ADHD
(pharmalogical & non pharmalogical)

3. The Case

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Introduction
- Attention deficit hyperactivity disorder (ADHD) is a
disorder that manifests in childhood with symptoms of
hyperactivity, impulsivity, and/or inattention.
- The symptoms affect cognitive, academic, behavioral,
emotional, and social functioning.

5. IN TERMS OF DIFFERENTIAL
DIAGNOSIS, WHICH SOMATIC
CAUSES OF ADHD-LIKE SYMPTOMS
SHOULD BE CONSIDERED/RULED
OUT?

6. + ADHD Differential Diagnosis
DDx
Hearing or
vision
impairmen
t
Lead
poisoning
Hyperthyr
oidism
Heart
Faliure
Hearing and vision screen
Measurement of blood
lead level
Laboratory studies
Medical history; echocardiograph

7. +
ADHD Differential Diagnosis
DDx
Substance
abuse
Undern
utrition
Seizure
disorder
Medicati
on side
effects
History; toxicology screening
Assessment of
growth
parameters
History; electroencephalography if
clinically indicated
History

8. HOW IS ADHD DIAGNOSED ?

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ADHD Diagnosis
- The American Psychiatric Association has defined
consensus criteria for the diagnosis of attention deficit
disorder (ADHD), which are published in the Diagnostic
and Statistical Manual of Mental Disorders Fifth
Edition (DSM-5)

10. +
ADHD Diagnosis
- For children <17 years, the DSM-5 diagnosis of ADHD
requires:
≥6 symptoms of
hyperactivity
and impulsivity
≥6 symptoms of
inattentionOR

11. + Hyperactivity and Impulsivity
Symptoms
Excessive fidgetiness (eg, tapping the hands or feet,
squirming in seat)
Difficulty remaining seated when sitting is required
Feelings of restlessness (in adolescents)
Blurting out answers too quickly
Difficulty playing quietly
Interruption or intrusion of others

12. +
Inattention Symptoms
Failure to provide close attention
to detail
Seems not to listen, even when
directly addressed
Difficulty maintaining attention in
play, school, or home activities
Forgetfulness in routine activities
Easily distracted by irrelevant
stimuli
Difficulty organizing tasks,
activities, and belongings

13. +
ADHD Diagnosis
- The symptoms of hyperactivity/impulsivity or inattention must:
1- Occur often.
2- Be present in more than one setting (eg, school and home).
3- Persist for at least six months.
4- Be present before the age of 12 years.
5- Impair function in academic, social, or occupational activities.
6- Be excessive for the developmental level of the child.
7- In addition, other physical, situational, or mental health conditions
that could account for the symptoms must be excluded.

14. WHICH TREATMENT OPTIONS
ARE AVAILABLE FOR ADHD
(PHARMALOGICAL & NON
PHARMALOGICAL)

15. Behavioral
Therapy
Pharmalogical
therapy
Combination
Therapy
TREATMENT
MODALITIES

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Behavioral Therapy
- Behavioral interventions include modifications in
the physical and social environment that are
designed to change behavior using rewards and
nonpunitive consequences.

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Behavioral Therapy
- Behavior therapy and environmental changes that can be used by
parents or teachers to shape the behavior of children with ADHD
include:
1- Maintaining a daily schedule.
2- Providing specific and logical places for the child to keep his
schoolwork, toys, and clothes.
3- Rewarding positive behavior (eg, with a “token economy”).
4- Using charts and checklists to help the child stay "on task”.
5- Limiting choices.
6- Finding activities in which the child can be successful (eg, hobbies,
sports).

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Pharmalogical Therapy
 Several different types of medications may be used to treat
ADHD:
1- Stimulants are the best-known and most widely used
treatments. Between 70-80 % of children with ADHD respond
positively to these medications.
Dextroamphetamine, Methylphenidate.

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Pharmalogical Therapy
2- Nonstimulants were approved for treating ADHD in
2003. This medication seems to have fewer side effects
than stimulants.
Alpha2-adrenergic Agonists, (SNRIs), Antidepressants

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Combination Therapy
- Combination therapy uses both behavioral/psychologic
interventions and medications.
- Combination therapy may be beneficial for school-aged
children and adolescents who have a suboptimal response
to pharmacotherapy or in preschool children who do not
respond to behavioral interventions

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Treatment Choice
- The treatment strategies for children with ADHD vary
according to age:
1- For preschool children (age 4 through 5 years) who meet
the diagnostic criteria for ADHD, we recommend behavior
therapy rather than medication as the initial therapy.

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Treatment Choice
2- For most school-aged children and adolescents (≥6 years
of age) who meet the diagnostic criteria for ADHD and
specific criteria for medication, we suggest initial treatment
with stimulant medication combined with behavioral
therapy, to improve core symptoms and target outcomes.

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References

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Block 3.1 Block 3.2 Block 3.3