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