Attention deficit hyperactivity disorder
|Attention deficit hyperactivity disorder|
Attention deficit hyperactivity disorder (ADHD) is a "behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. Although most individuals have symptoms of both inattention and hyperactivity-impulsivity, one or the other pattern may be predominant. The disorder is more frequent in males than females. Onset is in childhood. Symptoms often attenuate during late adolescence although a minority experience the full complement of symptoms into mid-adulthood."
ADHD occurs in adults also.
There are three types:
- Predominantly attention deficit disorder (ADD) (10%–15%)
- Predominantly hyperactive and impulsive (5%)
- Combined (80%)
About 10% of American children may have ADD. 
Twin studies suggest 76% of ADHD is inherited. Abnormalities of biogenic amine receptors may contribute to ADHD. ADHD is 3 times as common among adolescents of domestic adoption than nonadopted children.
A genome wide scan suggests abnormalities on chromosome 16.
ADHD may result from reduced inhibitory dopamine transmission in the midbrain. This may be due to an increase in dopamine plasma membrane transport protein density which may remove dopamine from the synapse too quickly, similar to a prior study on susceptibility to cocaine abuse.
Studies of the differences in brain and cognitive development in early childhood between children of the digital age of television and video games and those before raise the possibility that the digital visual environment leads to ADD and ADHD by disrupting the normal transition from right-brain visual processing to a balanced right- and left-brain cognitive and emotional state.
This view has enlisted some support by neurosurgeons, such as Restak (2003), who suggests that modern brain science, genetic mapping, and advances in imaging technology and psychopharmacology provide an unprecedented opportunity to show that the visual, high-volume, sound-byte environment in which today’s children live is even leading to a situation in which Attention Deficit Disorder and/or Attention Deficit Hyperactivity Disorder is on its way to becoming the norm.
The Multimodal Treatment Study of Children with ADHD randomized controlled trial concluded "for ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes." The components of this trial included over 14 months:
- Medications: "Were seen monthly for one-half hour at each medication visit. During the treatment visits, the prescribing physician spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child’s ADHD-related difficulties. The physicians, in addition, sought input from the teachers on a monthly basis."
- Behavior: "Families met up to 35 times with a behavior therapist, mostly in group sessions. These therapists also made repeated visits to schools to consult with children’s teachers and to supervise a special aide assigned to each child in the group. In addition, children attended a special 8-week summer treatment program where they worked on academic, social, and sports skills, and where intensive behavioral therapy was delivered to assist children in improving their behavior"
Several stimulant medications, such as methylphenidate and amphetamines (a 3:1 mixture of d-amphetamine to l-amphetamine is Adderall and others), are a mix of dopamine uptake inhibitors and adrenergic uptake inhibitors. Stimulants work by blocking the dopamine plasma membrane transport protein.
These drugs may increase cardiac complications.
Various behavioral programs have been studied. Health care providers, parents, and schools should collaborate in behavior therapy. In the United States, federal regulation provides for support to public schools for the education of children with disabilities such as attention deficit hyperactivity disorder (see below).
|American Academy of Family Physicians||Attention Deficit Disorder Association||National Resource Center (NRC) on AD/HD|
Amphetamines may help adults.
United States: Individuals with Disabilities Education Act (IDEA)
In the United States, Title 34 Part 300 of the Code of Federal Regulation provides for support to public schools for the education of children with 'other health impairments' such as attention deficit hyperactivity disorder.
Mortality may be increased.
Military recruits who do not require medications to finish high school or to hold a job may have similar military performance as recruits without ADHD.
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