Attention-Deficit Hyperactivity

Disorder
By
GROUP 6
ADHD Statistics

4-12% of all Indonesia. school-age children are estimated to

have this disorder.
5-10% of the entire Indonesia population
Males are 4 to 9 times more likely to have ADHD than are
females.
At least 50% of ADHD sufferers have another diagnosable
mental disorder.
Diagnosing ADHD: DSM-IV
Lacks attention to detail;
makes careless mistakes
Inattentiveness: has difficulty sustaining
attention
doesnt seem to listen
Has a minimum of 6
symptoms regularly for fails to follow
the past six months. through/fails to finish
projects
has difficulty organizing
Symptoms are present at tasks
abnormal levels for avoids tasks requiring
stage of development mental effort
often loses items
necessary for
completing a task
easily distracted
is forgetful in daily
activities
Diagnosing ADHD: DSM-IV
Fidgets or squirms
Hyperactivity/ Impulsivity: excessively
leaves seat when
Has a minimum of 6 inappropriate
symptoms regularly for the runs about/climbs
extensively when
past six months. inappropriate
has difficulty playing
Symptoms are present at quietly
abnormal levels for stage often on the go or
driven by a motor
of development
talks excessively
blurts out answers
before question is
finished
cannot await turn
interrupts or intrudes on
others
Diagnosing ADHD: DSM-IV

Symptoms causing
Additional impairment present before
age 7
Criteria:
Impairment from symptoms
occurs in two or more
settings
Clear evidence of
significant impairment
(social, academic, etc.)
Symptoms not better
accounted for by another
mental disorder
Problems of Diagnosis

Subjectivity of Criteria
Inconsistent
evaluations--presence of
symptoms usually given by teacher or
parent
Study by Szatmari et al (1989) showed
that the number of diagnosed cases of
ADHD decreased 80% when observations
of parent, teacher and physician were
used rather than just one source
Symptoms in females more subtle---leads
to underdiagnosis
ADHD and the Brain
Diminished arousal
of the Nervous
System
Decreased blood
flow to prefrontal
cortex and
pathways
connecting to
limbic system
(caudate nucleus
and striatum)
PET scan shows
decreased glucose Comparison of normal brain (left) and brain
of ADHD patient.
metabolism
throughout brain
 ADHD and the Brain II
Similarities of ADHD symptoms to those from injuries and lesions
of frontal lobe and prefrontal cortex
MRIs of ADHD patients show:
Smaller anterior right frontal lobe
abnormal development in the frontal and striatal regions
Significantly smaller splenium of corpus callosum
decreased communication and processing of information between
hemispheres
Smaller caudate nucleus
What causes ADHD?
Underlying cause of these differences is
still unknown; there is much conflicting
data between studies
Strong evidence of genetic component
Predominant theory: Catecholamine
neurotransmitter dysfunction or
imbalance
decreased dopamine and/or norepinephrine uptake in brain
theory supported by positive response to stimulant treatment

Recent study indicates possible lack of

serotonin as a factor in mice
Dopamine in the Brain

Scientific American
Http//www.sciam.com/1998/0998issue/0998barkely.html#link1
Genetic Linkages to ADHD
Twinstudies by Stevenson, Levy et al, and
Sherman et al indicate an average
heritability factor of .80
Biederman et al reported a 57% risk to
offspring if one parent has ADHD.
Dopamine genes
DA type 2 gene
DA transporter gene (DAT1)
Dopamine receptor (DRD4, repeater gene) is over-
represented in ADHD patients
DRD4
DRD4 is most likely contributor
DRD4 affects the post-synaptic sensitivity in the prefrontal
and frontal cortex
This region of cortex affects executive functions and
attention
Executive functions include working memory,
internalization of speech, emotions, motivation, and
learning of behavior
Treatment
Counseling of individual and family
Stimulants
Tricyclic antidepressants
Bupropion
Clonidine
Stimulants
Exact mechanism unknown
Raise activity level of the CNS by
decreasing fluctuations of activity or
lowering threshold needed for arousal
Similar
in structure to NE and DA, and may
mimic their actions
At least 75% have positive response with
single dose
95% respond well to stimulant treatment
Includemethylphenidate,
dextroamphetamine and pemoline
Methylphenidate
Is a piperidine Taken orally, 2-3
derivative commonly times a day as
known as Ritalin needed
Is believed to act as Behavioral effects
dopamine agonist in start within 1/2 hour
synaptic cleft to hour after
Stimulates frontal- ingestion, peaking at
striatal regions 1 and 3 hours
Dosage (5-20 mg) Also comes in
must be adjusted to Sustained-Release
each patient form, whose effects
last approximately
twice as long.
Effects of MPH
Elevates mood
Raises arousal of CNS and cerebral blood flow
Increases productivity
Improves social interactions
Increases heart rate and blood pressure
Has little or no abuse potential
Side Effects
Common: Mild:
decreased anxiety/
appetite depression
insomnia irritability
behavioral Rare:
rebound tics (Tourettes
head and Syndrome)
stomach aches overfocussing
liver problems or
Also thought to cause rash (Pemoline
temporary height and only)
weight suppression
 Outcome
ADHD can persist into adulthood, but usually symptoms gradually
diminish
When it persists into adulthood, it usually requires ongoing
treatment and counseling
most will develop another disorder (especially learning disability,
ODD, depression, and/or conduct disorder)
Without treatment:

antisocial and deviant behavior

increased rates of divorce, moving
violations, incarceration, and
institutionalization