A brief presentation on ADHD along with its latest research.

1. Manoj Pradeep.B, Group 3, Faculty Of Medicine, Tbilisi State Medical University.

3. It is the most common neurobehavioral
disorder of childhood.
One of the most prevalent chronic health
conditions affecting school-aged children
It is the most extensively studied mental
disorder of childhood

4. Inattention
Motor
overactivity
and motor
restlessness
Poor impulse
control and
decreased self-inhibitory
capacity

5. Directly affects Dopamine
Neurotransmission.
 Dopamine Transporter
Gene (DAT1)
 Dopamine 4 Receptor Gene
(DRD4)
Additional genes that may
contribute to ADHD include
 DOCK2 - involved in
cytokine regulation,
 A sodium-hydrogen
exchange gene, and
 DRD5, SLC6A3, DBH,
SNAP25, SLC6A4, and
HTR1B.
Toxins:
 Alcohol
 Tobacco
 Lead
 Organophosphates
 Abnormal brain structure and traumatic
brain injury.
 Psychosocial family stressors : Increase
symptoms

6.  Reduction in brain volume with proportional decrease in left sided pre-frontal
cortex.
 Connection tracts between prefrontal cortex and striatum are also lost.
Loss Of Executive
Functions,
Personality
& Mood
*The criteria for an executive function deficit
are met in 30–50% of children and
adolescents with ADHD

7. Dopamine
Hypothesis:
Decreas
ed
Dopami
ne
Transpo
Adaptive rters
Mechanisms
Increase
d
Dopami
ne
Receptor
s

9. The behavior must be developmentally inappropriate.
Must begin before age 7 years, must be present for at least 6 months, must be
present in 2 or more settings.
Must not be secondary to another disorder.
3 Sub Types of
ADHD

10. Inattentive type
Hyperactive-impulsive
type
Combined type
Common in females
Common in males

11. Motor restlessness
Aggressive and
disruptive behavior
preschool children
Disorganized,
distractible, and
inattentive symptoms

13. A systematic clinical interview is mandatory for a comprehensive
understanding of whether the symptoms meet the diagnostic
criteria for ADHD
Behavioral Rating Scale
 Behavior rating scales are useful in establishing the magnitude and
pervasiveness of the symptoms, but are not sufficient alone to make a
diagnosis of ADHD.
 There are a variety of well-established behavior rating scales
 The Conner Rating Scale
 The ADHD Index
 The Swanson, Nolan, and Pelham Checklist (SNAP)
 The ADD-H: Comprehensive Teacher Rating Scale (AcTERS).

14. The Conner Rating
Scale

15. Teachers Rating Scale

16.  There are no laboratory tests available to
identify ADHD in children.
 Considering a Tox-screen in children with
suspected exposure.
 Behavior in the structured laboratory setting
may not reflect the child's typical behavior in
the home or school environment. Therefore,
reliance on observed behavior in a physician's
office may result in an incorrect diagnosis.
 Computerized attentional tasks and
electroencephalographic assessments are not
needed to make the diagnosis.

17. This study focused on 35 adults who were diagnosed with ADHD as children; 13 of them
still have the disorder, while the rest have recovered.
Shifting brain patterns
If it can be confirmed, this pattern could become a target for potential modification to
help patients learn to compensate for the disorder without changing their genetic
makeup.
Lingering problems
The researchers now plan to investigate how ADHD medications influence the brain's
default mode network, in hopes that this might allow them to predict which drugs will
work best for individual patients

19. Chronic illnesses : migraine headaches, absence seizures, asthma and allergies,
hematologic disorders, diabetes, childhood cancer affect up to 20% of children in the U.S.
and may impair children's attention and school performance.
Substance abuse : In older children and adolescents it may result in declining school
performance and inattentive behavior.
Sleep disorders : including those secondary to chronic upper airway obstruction from
enlarged tonsils and adenoids, frequently result in behavioral and emotional symptoms.
Behavioral and emotional disorders may cause disrupted sleep patterns.
Depression and anxiety : may cause many of the same symptoms as ADHD (inattention,
restlessness, inability to focus and concentrate on work, poor organization, forgetfulness),
but may also be comorbid conditions.
Although ADHD is believed to be due to primary impairment of attention, impulse
control, and motor activity, there is also a high prevalence of comorbidity with other
psychiatric disorders.

21. The parents and child should be educated with regard to the ways in which ADHD can affect learning,
behavior, self-esteem, social skills, and family function.
Goals must be set for the family to improve the child's interpersonal relationships, develop study skills,
and decrease disruptive behaviors.
 Such treatments occur in the time frame of 8–12 sessions.
 The goal of such treatment is for the clinician to identify targeted behaviors that cause
impairment in the child's life and for the child to work on progressively improving his
or her skill in these areas.
 The clinician should guide the parents and teachers in implementing rules,
consequences, and rewards to encourage desired behaviors.

22. METHYLPHENIDATE :
Mechanism – Unclear.
Methylphenidate is a norepinephrine and dopamine reuptake inhibitor  DAT4 inh.
DEXMETHYLPHENIDATE
Increases catecholaminergic neurotransmission by inhibiting the dopamine transporter (DAT)
and norepinephrine transporter (NET) particularly in the striatum and meso-limbic system
DEXTROAMPHETAMINE
Activation of TAAR1 increases cAMP production via adenylyl cyclase activation and inhibits the
function of the dopamine transporter, norepinephrine transporter, and serotonin transporter, as
well as inducing the release of these monoamine neurotransmitters
TRICYCLIC ANTIDEPRESSANTS
Are currently being replaced by SSRI’s and SNRI’s
by blocking the serotonin transporter (SERT) and the norepinephrine transporter(NET)
Selective Nor-epinephrine Reuptake Inhibitors [NRI’s]
Alpha Agonists:
Clonidine: Presynaptic Alpha-2 Blockers.

24. A childhood diagnosis of ADHD often leads to persistent ADHD throughout the life span.
 From 60–80% of children diagnosed with ADHD continue to experience symptoms in
adolescence, and up to 40–60% of adolescents exhibit ADHD symptoms into adulthood.
In children diagnosed with ADHD, a reduction in hyperactive behavior often occurs with
age. However, other symptoms associated with ADHD can become more prominent with
age, such as inattention, impulsivity, and disorganization, and these exact a heavy toll on
young adult functioning.
 A variety of risk factors can affect children with untreated ADHD as they become adults.
These risk factors include engaging in risk-taking behaviors (sexual activity, delinquent
behaviors, substance use), educational underachievement or employment difficulties, and
relationship difficulties. With proper treatment, the risks associated with the disorder
can be significantly reduced.

25. Literature:
• Natoshia Raishevich Peter Jensen : Nelson’s Textbook Of Pediatrics 8th Edition
• Parthasarathy A : IAP Textbook Of Pediatrics 4th Edition
Online References:
Aaron T. Mattfeld, John D.e. Gabrieli, Joseph Biederman, Thomas Spencer, Ariel Brown,
Amelia Kotte, Elana Kagan, and Susan Whitfield-Gabrieli. Brain differences between
persistent and remitted attention deficit hyperactivity disorder. Brain, June 2014
DOI: 10.1093/brain/awu137
Brookhaven National Laboratory: http://www.bnl.gov/newsroom/news.php?a=1565
Center of Disease Control : http://www.cdc.gov/ncbddd/adhd/
WebMD: http://www.webmd.com/add-adhd/default.htm?names-dropdown
National Institute of Mental Health : http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-
disorder-adhd/index.shtml
Wikipedia : http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder
http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders