Attention deficit/hyperactivity disorder (ADHD)
From Standard of Care
Symptoms of inattention, impulsiveness and hyperactivity.
Frequent distractibility, inability to sustain attention to tasks, goals, and to others.
Unable to control impulsive decisions and behaviors.
Approximately 4.4% of adults in the United States have this process ( Kessler RC et al).
Characterized by impaired attention span, hyperactivity, and impulsivity.
Adult patients frequently cannot or will not take medications and many have poor therapeutic response to such agents ( Prince J et al.).
Adult patients may only respond partially to drugs and may continue to experience significant symptoms.
Associated with excessive talking, frequent interruption of others, unable to delay gratification, inability to wait for things, more prone to risk taking.
Many have difficulty controlling activity levels.
Typically fidgety, restless, irrelevant behavior, hyperactive and have behavior that is inappropriate to the situation.
Impairs school and work performance.
Interferes with personal relationships.
Reduces chance of success in many aspects of life.
Increased the risk of tobacco use, injuries, motor vehicle accidents and substance abuse.
Hyperactivity more likely to be present in childhood, and decreases by adolescence and adulthood, with replacement with restlessness and need to be busy.
More than 60% have symptoms into adolescence and adulthood.
Most commonly diagnosed in children between ages of 6 and 12 years.
Approximately 4-8% of children are diagnosed with ADHD.
Hyperactivity more likely to be present in childhood, and decreases by adolescence and adulthood, with replacement with restlessness and need to be busy.
Approximately 10-35% of patients have immediate family members with ADHD.
30% of siblings of patients with ADHD also have the disorder.
Parents od patients with ADHD are at high risk of having the process.
Divided into three types in the Diagnostic and Statistical Manual for Mental disorders DSM-IV.
Combined Type is the most common type accounting for 65% of cases and involves all characteristic findings.
The Predominantly Hyperactive Type lacks sufficient problems with inattentiveness to be diagnosed as the Combined Type, manifests with impulsive and hyperactive behavior.
Predominantly Hyperactive Type felt to be an early stage of Combined Type disease, as up to 90% will develop sufficient problems with attention and distractibility to be diagnosed later.
Remaining cases are diagnosed with a mild type of Combined Type disease.
Predominantly Inattentitive Type of disease have attention problems but do not have excessive activity levels or poor impulse control.
Genetic studies have identified gene polymorphisms associated with this process and include two dopamine genes (DRD4 and DAT 1 genes).
Brain dopamine neuro-transmissionis disrupted in this process and may be related to symptoms of inattention and impulsivity.
Maternal smoking and lead levels may affect the dopamine system of the brain.
Patients have reward and motivation deficits and children with this problem do not modify their behavior in the face of changing reward conditions.
The mesoaccumbens dopamine pathway, which projects from the ventral segmental area in the mid brain to the nucleus accumbens is critically involved in reward and motivation, and may be responsible for such deficits in ADHD (Johansen EB).
Up to 80%-85% of properly diagnosed children have improved symptoms with stimulant medications.
Medications are prescribed for more than 2.7 million children with ADHD and use of such drugs is associated with an increaed risk of serious cardiovascular events, but the magnitude is small with 3.1 serious cardiovascular events per 100,000 person years reported in children and young adults.
