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B Y: S A D A N I A M I L L E R
ATTENTION DEFICIT- HYPERACTIVE DISORDER (ADHD)
INTRODUCTION:
Is a neurodevelopment disorder resulting in a pattern of inattention and/or hyperactivity that causes impairment in social, emotional, cognitive, and academic functioning (Rader, McCauley, & Callen, 2009)
HISTORICAL BACKGROUND:
• 1798- Sir Alexander Crichton- a Scottish doctor and author wrote about a “mental restlessness”
• 1902- Dir. George Still- a British Pediatrician, “defect in moral control”
• 1917 and 1918- In North America it was called a “minimal brain disease condition/brain injury child syndrome” by many Pediatricians
• 1950’s- Hyperkinetic Impulse Disorder• 1968- it was called Hyperkinetic Reaction in childhood• 1980- Virginia Douglas had it renamed as Attention-Deficit
Disorder (ADD) in DSM- 3• Late 1980’s- renamed Attention Deficit-Hyperactivity Disorder
(ADHD) in DSM-IV (1994 edition)
ETIOLOGY
• Family hx• Increase in blood lead level• Maternal alcohol/drug abuse• Traumatic brain injury (frontal lobe)• Perinatal hypoxia • Low birth weight infant• Psychosocial deprivation• Thyroid dysfunction• EFA (essential fatty acid) deficiencies• Food allergies• Sugar and food additive’s
PREVALENCE:
• 2-3% in females• 6-9% in males• 1-2% in 6-12 year old females• 3-4.5% in 6-12 year old males• 3-5% in school-age children (limited evidence on
adolescence and adulthood)• Varies by culture• As children mature, signs of excessive
movement are less common, but they still have jitteriness or restlessness
3 SUBTYPES:
• Inattentive (6 or more symptoms within the inattentive category)
• Hyperactive-Impulse (6 or more symptoms within the hyperactive-impulse category)
• Inattentive and Hyperactive-Impulse (6 or more in inattentive and 6 or more in hyperactive-impulse category)
INATTENTIVE:
• Fails to give close attention to details or makes careless mistakes in schoolwork
• Has difficulty keeping attention during tasks or play• Does not seem to listen when spoken to directly• Does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace• Has difficulty organizing tasks and activities• Avoids or dislikes tasks that require sustained mental
effort (such as schoolwork)• Often loses toys, assignments, pencils, books, or tools
needed for tasks or activities• Is easily distracted• Is often forgetful in daily activities
HYPERACTIVE-IMPULSIVE:
Hyperactive symptoms: (some of the symptoms)• Fidgets with hands or feet or squirms in seat• Leaves seat when remaining seated is expected• Runs about or climbs in inappropriate situations• Has difficulty playing quietly• Is often "on the go," acts as if "driven by a motor," talks
excessivelyImpulsive symptoms: (some of the symptoms)
• Blurts out answers before questions have been completed
• Has difficulty awaiting turn• Interrupts or intrudes on others (butts into conversations
or games)
PHYSIOLOGY ASPECTS:
• Damage to prefrontal cortex (decreasing prefrontal cortex activity)
• 5% brain volume with greater reductions in the prefrontal cortex, caudate nucleus, cerebellum, and corpus callosum (smaller brain volume is linked to ADHD)
• Decrease activity in medial cingulate areas • Hyperactivity in the dorsal parts of the stratum including the
caudate nucleus, putamen, increase thalamic, and insular activity
• Hypo responsiveness in the ventral-striatal reward system including the nucleus accumbens
• Myelin Sheath is damaged
CONT. PHYSIOLOGY ASPECTS:
• All structures of the dorsolateral and medial-frontal areas, pre-supplementary motor area, cingulate areas are affected except the pariental area
• Altered in olfactory and basil functioning• Altered amygdala (decreased) and hippocampus volume
(increased)• Putamen and globus pallidus are smaller (9-15 year
olds)• Decrease in DHA (leads to decrease in serotonin and
dopamine neurotransmission)• Increase in ethane in exhalant• Glutamatergic system abnormal (information processing)
ROLES:
• Dorsolateral prefrontal cortex- planning and organizing behavior
• Anterior cingulate cortex- cognition and motor control• Dorsal striatum- controlling responses• Cerebellum- coordinating motor activities, timing, and
shifting attention• Caudate nucleus and basal ganglia- language, learning,
memory, attention, and control of behavior responses
DIAGNOSING:
• Functional MRI • PET Scan • Stroop Test • Other batteries of test
IMAGES: PET SCAN
FUNCTIONAL MRI
STROOP TEST
TREATMENT:
Both therapy and medication:Drug therapy:
• Non-stimulus (aggressive behavior, impulsivity, hyperactivity, anxiety, insomnia, and tics)
• Stimulus (decrease inattention, distractractibility, over activity and impulsivity)
• Dopamine agonist • Medication targets
• Behavior modifications• Lifestyle changes• Psychotherapy
Natural Therapy:• Increase in Mg, Omega 3, and/or DHA/EFA’s• Video: http://
www.youtube.com/watch?v=u82nzTzL7To&feature=youtube_gdata_player
REFERENCESAguiar, A., Eubig, P. A., & Schantz, S. L. (2010). Attention deficit/hyperactivity disorder: a
focused overview for children's environmental health researchers. Environmental Health Perspectives, 118(12), 1646-1653. doi:10.1289/ehp.1002326
Bussing, R., & Grohol, J. (2012). Attention Deficit Disorder: An Introduction to ADD/ADHD. Psychcentral. Retrieved from http://www.psychcentral.com/disorders/adhd
Conzelmann, A., Pauli, P., Mucha, R. F., Jacob, C. P., Gerdes, A. M.,Romanos, J., & ... Weyers, P. (2010). Early attentional deficits in an attention-to-prepulse paradigm in ADHD adults. Journal Of Abnormal Psychology, 119(3), 594-603. doi:10.1037/a0019859
Craig Berridge. (2006, June 29). "Study Reveals How ADHD Drugs Work In Brain." Medical News Today. Retrieved fromhttp://www.medicalnewstoday.com/releases/46041.php.
Diagnostic and Statistical Manual of Mental Disorders DSM-IV. American Psychiatric Association, 4th edition. Pp. 78-84
Dibbets, P., Evers, E. T., Hurks, P. M., Bakker, K., & Jolles, J.(2010). Differential brain activation patterns in adultattention-deficit hyperactivity disorder (ADHD) associated with taskswitching. Neuropsychology, 24(4), 413-423. doi:10.1037/a0018997
Encyclopedia of Mental Health. (1998) Academic Press. (1) A-Di pp.169-182
CONT. REFERENCESFisher, T., Aharon-Peretz, J., & Pratt (2011). Disregulation of response inhibition in adult
attention-deficit hyperactivity disorder (ADHD): An ERP Study. Clinical Neurophysiology, 122, 2390-2399. Retrieved from www.elsevier.com/locate/clinph
Mejetis, C., & Zabriskie, M. (2008) Alternative and Complimentary Therapies?Mount Sinai Press Office (2006). High dopamine transporter levels not correlated with ADHD.
Brookhaven National Laboratory. Retrieved from http://www.bnl.gov/bnlweb/pubaf/pr/PR_print.asp?prID=06-124
Perlov, E., Philipsen, A., van Elst, L., Ebert, D., Henning, J., Maier,S., & ... Hesslinger, B. (2008). Hippocampus and amygdala morphology in adults with attention-deficit hyperactivity disorder. Journal Of Psychiatry & Neuroscience, 33(6), 509-515.
Rader, R., McCauley, L., & Callen, E.C. (2009). Current strategies in the diagnosis and treatment of childhood attention-deficit/ hyperactivty disorder. American Family Physician, 79, 657-665
Roberts, W., Fillmore, M.T., & Millich, R. (2011). Separating automatic and intentional inhibitory mechanisms of attention in adults with attention-deficit/hyperactivity disorder. Journal of Abnormal Psychology, 120, 223-233. doi: 10.1037/a0021408
UC Davis Health System (2007). Establishing a comprehensive ADHD research and treatment program. Retrieved from http://www.ucdmc.ucdavis.edu/welcome/features/20071128_m nd_adhd/index.html
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