Attention Déficit Hyperactivity Disorder
It is a disorder that is characterized by a persistent pattern of inattention and/or
hyperactivity/impulsivity that interferes with functioning or development which often persists
into adolescence and adulthood.
The diagnosis of ADHD demands thorough history taking, application of standardized rating
scales, and close attention to the patient’s behavior and subjects’ reports.
It is a developmental condition of inattention and distractibility, with or without accompanying
hyperactivity.
ADHD is characterized by inattentiveness, overactivity, and impulsiveness.
ADHD is a common disorder, especially in boys, and probably accounts for more child mental
health referrals than any other single disorder.
The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity and
impulsivity more common than generally observed in children of the same age.
Statistics and Incidences
In 2016, an estimated 6.1 million US children aged 2-17 years (9.4%) were diagnosed with ADHD.
Of these children, 5.4 million currently had ADHD, which was 89.4 % of children ever diagnosed
with ADHD and 8.4% of all US children 2-17 years of age.
According to a study by CDC researchers, more than 1 in 10 (11%) US school-aged children (4–17
years) had received an ADHD diagnosis by a health care provider by 2011, as reported by
parents.
ADHD prevalence varies by race and ethnicity, with Mexican children having consistently lower
prevalence compared with other racial or ethnic groups.
In children, ADHD is 3–5 times more common in boys than in girls.
The percentages in each group are not well established, but at least an estimated 15–20% of
children with ADHD maintain the full diagnosis into adulthood.
According to the Attention Deficit/Hyperactivity Disorder (AD/HD) Society of the Philippines, an
estimated 3 to 5 percent of the population aged 0 to 14 years in the Philippines have ADHD.
Causes
Psychodynamic theory
The child is fixed in the symbiotic phase of development and has not differentiated self from
mother.
Ego development is retarded
The impulsive behavior is dictated by the ID
Biologic theories
Genetics - Parents and siblings of children with ADHD are 2-8 times more likely to develop ADHD
than the general population, suggesting that ADHD is a highly familial disease.
CNS abnormalities, such as presence of neurotoxins, cerebral palsy, epilepsy and other
neurological disorders
Neuro maturational delays, catecholamine deficits, altered glucose metabolism in the brain and
frontal lobe dysfunction.
Perinatal insults such as substance abuse during pregnancy, poor maternal nutrition, premature
labor, and anoxia; brain injuries during or after birth.
Theories of family dynamics
There is a dysfunctional spousal relationship, the focus of the disturbance is displaced into the
child, whose behavior in time begins to reflect the patterns of the dysfunctional system.
Disorganized or chaotic environment and child abuse or neglect may also be a factor.
Environment
According to one study, exposure to second-hand smoke in the home is associated with a higher
frequency of mental disorder among children.
Personality factors
Although there remains much evidence for the genetic etiology of ADHD, one study indicated
, Criteria
In DSM-5, people with ADHD exhibit a persistent pattern of inattention and/or hyperactivity-impulsivity
that interferes with functioning or development
Inattention
Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age
17 years and older and adults; symptoms of inattention have been present for at least 6 months, and
they are inappropriate for developmental level:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work,
or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in
the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of
time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools,
wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted.
Is often forgetful in daily activities.
Hyperactivity and Impulsivity
Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for
adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present
for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental
level:
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may
be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
Several symptoms are present in two or more settings, (such as at home, school or work; with
friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school,
or work functioning.
The symptoms are not better explained by another mental disorder (such as a mood disorder,
anxiety disorder, dissociative disorder, or a personality disorder).
The symptoms do not happen only during the course of schizophrenia or another psychotic
disorder.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-
impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not
hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-
impulsivity, but not inattention, were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
It is a disorder that is characterized by a persistent pattern of inattention and/or
hyperactivity/impulsivity that interferes with functioning or development which often persists
into adolescence and adulthood.
The diagnosis of ADHD demands thorough history taking, application of standardized rating
scales, and close attention to the patient’s behavior and subjects’ reports.
It is a developmental condition of inattention and distractibility, with or without accompanying
hyperactivity.
ADHD is characterized by inattentiveness, overactivity, and impulsiveness.
ADHD is a common disorder, especially in boys, and probably accounts for more child mental
health referrals than any other single disorder.
The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity and
impulsivity more common than generally observed in children of the same age.
Statistics and Incidences
In 2016, an estimated 6.1 million US children aged 2-17 years (9.4%) were diagnosed with ADHD.
Of these children, 5.4 million currently had ADHD, which was 89.4 % of children ever diagnosed
with ADHD and 8.4% of all US children 2-17 years of age.
According to a study by CDC researchers, more than 1 in 10 (11%) US school-aged children (4–17
years) had received an ADHD diagnosis by a health care provider by 2011, as reported by
parents.
ADHD prevalence varies by race and ethnicity, with Mexican children having consistently lower
prevalence compared with other racial or ethnic groups.
In children, ADHD is 3–5 times more common in boys than in girls.
The percentages in each group are not well established, but at least an estimated 15–20% of
children with ADHD maintain the full diagnosis into adulthood.
According to the Attention Deficit/Hyperactivity Disorder (AD/HD) Society of the Philippines, an
estimated 3 to 5 percent of the population aged 0 to 14 years in the Philippines have ADHD.
Causes
Psychodynamic theory
The child is fixed in the symbiotic phase of development and has not differentiated self from
mother.
Ego development is retarded
The impulsive behavior is dictated by the ID
Biologic theories
Genetics - Parents and siblings of children with ADHD are 2-8 times more likely to develop ADHD
than the general population, suggesting that ADHD is a highly familial disease.
CNS abnormalities, such as presence of neurotoxins, cerebral palsy, epilepsy and other
neurological disorders
Neuro maturational delays, catecholamine deficits, altered glucose metabolism in the brain and
frontal lobe dysfunction.
Perinatal insults such as substance abuse during pregnancy, poor maternal nutrition, premature
labor, and anoxia; brain injuries during or after birth.
Theories of family dynamics
There is a dysfunctional spousal relationship, the focus of the disturbance is displaced into the
child, whose behavior in time begins to reflect the patterns of the dysfunctional system.
Disorganized or chaotic environment and child abuse or neglect may also be a factor.
Environment
According to one study, exposure to second-hand smoke in the home is associated with a higher
frequency of mental disorder among children.
Personality factors
Although there remains much evidence for the genetic etiology of ADHD, one study indicated
, Criteria
In DSM-5, people with ADHD exhibit a persistent pattern of inattention and/or hyperactivity-impulsivity
that interferes with functioning or development
Inattention
Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age
17 years and older and adults; symptoms of inattention have been present for at least 6 months, and
they are inappropriate for developmental level:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work,
or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in
the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of
time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools,
wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted.
Is often forgetful in daily activities.
Hyperactivity and Impulsivity
Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for
adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present
for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental
level:
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may
be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
Several symptoms are present in two or more settings, (such as at home, school or work; with
friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school,
or work functioning.
The symptoms are not better explained by another mental disorder (such as a mood disorder,
anxiety disorder, dissociative disorder, or a personality disorder).
The symptoms do not happen only during the course of schizophrenia or another psychotic
disorder.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-
impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not
hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-
impulsivity, but not inattention, were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
