NR 602 WEEK 2 GRAND ROUNDS - ADHD

What is ADHD? Attention Deficit Hyperactivity Disorder, also known as ADHD, is a neurobehavioral or neurodevelopmental disorder that commonly presents in children and teens (Brown et al., 2017). ADHD can be a psychosocial burden that can persist into adulthood (Albrecht, Sandersleben, Gevensleben, & Rothenberger, 2015). ADHD is considered a heterogeneous disease, therefore making treatment a challenge (Albrecht, Sandersleben, Gevensleben, & Rothenberger, 2015). Signs and symptoms of ADHD may include persistent patterns of poor concentration, inattention, overactivity, and/or impulsivity (Ahmann, 2017; Albrecht, Sandersleben, Gevensleben, & Rothenberger, 2015; Silbert-Flagg & Sloand, 2017). Patho – The etiology of ADHD is not well understood, however, studies suggest that there is a dysfunction of the neurotransmitters responsible for dopamine and norepinephrine release and within the prefrontal cortex of the brain (Hollier, 2016). There are some factors that seem to contribute to the diagnosis, these factors include motor and sensory influences, psychosocial, behavioral, genetic, biochemical, physiologic, and environmental influences (Hollier, 2016). Some seem to believe that deficits from ADHD can be seen when the brain is at rest, which can lead to impeding of activity in the neuronal networks involved with processing tasks, which leads to problems with regulation and therefore promotes periodic attention lapses (Albrecht, Sandersleben, Gevensleben, & Rothenberger, 2015). Epidemiology – ADHD affects about 5 to 11 percent of children and teenagers and it affects all cultural backgrounds and nationalities (Albrecht, Sandersleben, Gevensleben, & Rothenberger, 2015; Hollier, 2016). Males seem to be more affected than females and females are usually diagnosed later than males (Hollier, 2016). Generally, two out of three people experience ADHD into adulthood (Albrecht, Sandersleben, Gevensleben, & Rothenberger, 2015). Risk factors – NR 602 WEEK 2 GRAND ROUNDS - ADHD The predominant risk factor is believed to be family history. Genetic factors explained 76 percent and 92 percent of the covariance between hyperactivity and inattention (Hollier, 2016). The other possible risk factors linked to ADHD include increased lead levels, traumatic brain injuries, and poor prenatal health such as alcohol abuse, smoking, drug abuse, preeclampsia, low birth weight, and pre-natal and peri-natal stress (Hollier, 2016). Clinical physical assessment findings – The Diagnostic and Statistical Manual, fifth edition (DSM-V), says there are 3 subtypes of ADHD, which include hyperactive and impulsive, inattentive, or a combination of all 3 (DSM-V, 2013; Silbert-Flagg & Sloand, 2017). In order to be diagnosed with ADHD, one must have 6 or more symptoms in one of the categories or multiple symptoms from both categories and these symptoms should be present before the age of 12 years old (DSM-V, 2013; Silbert-Flagg & Sloand, 2017). The DSM-V criteria for inattention includes poor attention to detail/careless mistakes, hard time keeping focused or paying attention during activities, failure to pay attention even when spoken to directly, difficulties following directions and completing assignments on time, disorganization with tasks and activities, forgetful, easily distracted, may avoid activities that require focused mental attention, and frequent loss of items needed to complete certain tasks or assignments (DSM-V, 2013; Silbert-Flagg & Sloand, 2017). The DSM-V criteria for hyperactivity/impulsivity includes difficulty staying seated when it’s expected, fidgeting and squirming, boundless energy for activities such as running and climbing, difficult time with quiet activities, excessive talking, answers questions before question is done being asked, difficult time waiting for their turn, and often interrupts others and acts meddlesome (DSM-V, 2013; Silbert-Flagg & Sloand, 2017). 3 differential diagnoses – - Autism Spectrum Disorder (ASD) is a neurodevelopmental disease that presents in childhood and lasts a lifetime (Woodburt-Smith et al., 2017). ASD is associated with a rare inherited genetic mutation and other complex structural gene variations (Woodburt-Smith et al., 2017). However, most of the genes found with ASD are autosomal (Woodburt-Smith et al., 2017). ASD seems to affect males more than females therefore leading researchers to believe there is a sex chromosome role involved as well (Woodburt-Smith et al., 2017). Characteristics of ASD include difficulty interacting and communicating with others, limited interest in most activities, repetitive behaviors, and these symptoms are noticeable within their first 2 years of life (Hollier, 2016). - Learning Disabilities (LDs) are heterogeneous disorders that inhibit the ability of the patient to acquire, retrieve, and use information appropriately (Hollier, 2016). These children typically have average to above-average intellectual abilities yet these disorders severely interfere with these abilities (Hollier, 2016). The clinical features of LDs manifest as difficulties with reading, writing, math skills, and generalized memory problems (Hollier,