Attention Deficit Disorder And Hyperactivity (Add, Adhd)

Attention deficit disorder with or without hyperactivity (ADHD) is a syndrome of inattention, hyperactivity and impulsivity. The 3 types of ADHD are inattention, hyperactivity / impulsivity, or a combination thereof. The diagnosis is made by clinical criteria. Treatment is usually with medication from the group of stimulants, possibly accompanied by behavioral therapy and / or legal action.

Attention deficit disorder is considered as interference in the development of the nervous system. Neurodevelopmental disorders are neurologically based conditions that occur early in childhood, usually affecting before starting school and the development of personal, social, academic and / or professional functioning. They usually include difficulty acquiring, in maintaining or application of specific skills or of rows of information. Disturbances in the development of the nervous system can result in dysfunction of attention, memory, perception, language, problem solving and social interaction. Other common neurological developmental disorders autism spectrum disorders, learning disorders include, for example, 15, Dyslexieund limited intellect.

Attention deficit disorder with or without hyperactivity (ADHD) is a syndrome of inattention, hyperactivity and impulsivity. The 3 types of ADHD are inattention, hyperactivity / impulsivity, or a combination thereof. The diagnosis is made by clinical criteria. Treatment is usually with medication from the group of stimulants, possibly accompanied by behavioral therapy and / or legal action. Attention deficit disorder is considered as interference in the development of the nervous system. Neurodevelopmental disorders are neurologically based conditions that occur early in childhood, usually affecting before starting school and the development of personal, social, academic and / or professional functioning. They usually include difficulty acquiring, in maintaining or application of specific skills or of rows of information. Disturbances in the development of the nervous system can result in dysfunction of attention, memory, perception, language, problem solving and social interaction. Other common neurological developmental disorders autism spectrum disorders, learning disorders include, for example, 15, Dyslexieund limited intellect. Although some experts have previously considered ADHD as a behavioral disorder, this was probably because comorbid behavior disorders, especially oppositional defiant disorder and conduct disorder are common. ADHD affects approximately 5-11% of school children. Nevertheless my many experts, ADHD would diagnosed, mainly because the criteria are not applied correctly. After the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are three types: predominantly inattentive predominantly hyperactive / impulsive combined total there ADHD about twice as often in boys, although the conditions on the type vary. The predominantly hyperactive / impulsive form occurs in boys before 2-9 times more likely to pay attention disorder is distributed equally to both sexes. There appears to be a familial predisposition for ADHD. The etiology of ADHD is unknown. Possible causes include genetic, biochemical, sensory-motor, physiological and behavioral factors. Risk factors include low birth weight (<1500 g), head injury, iron deficiency, obstructive sleep apnea and lead exposure and prenatal exposure to alcohol, tobacco and cocaine. Less than 5% of children with ADHD have proven neurological diseases. One always assumes again that changes in dopaminergic and adrenergic system are the cause of the syndrome with a decreased activity or stimulation in the upper brainstem and midbrain front. ADHD in adults Although ADHD is considered a disorder of children and always begins in childhood, it remains up into adulthood in about half of cases. Although the diagnosis may not be detected until adolescence or adulthood occasionally, some manifestations before the age of 12 years should have been present. In adults, symptoms difficulty concentrating difficulty tasks to complete mood swings impatience difficulties in maintaining relationships hyperactivity in adults manifests itself usually more in the form of restlessness and anxiety than in the form of overt motor hyperactivity that occurs in young children. Adults with ADHD have a higher risk of unemployment, reduced levels of education and increased rates of drug abuse and crime in general. Car Accidents and injuries are common. ADHD can be difficult to diagnose in adulthood. The symptoms can be similar to those of mood disorders, anxiety disorders, and substance use disorders. Since infomation about childhood symptoms may be unreliable, doctors need to see school records or ask family members to confirm the existence of appearances before the age of 12 years. Adults with ADHD can benefit from the same types of stimulants, take the children with ADHD. You can also benefit from advice to improve their time management and other coping strategies. Symptoms and signs Symptoms often begin before the age of 4, and in any event before 12 The main age at diagnosis is between 8 and 10 years. Nevertheless, sometimes the patients are diagnosed with the inattentive type mainly after puberty. The core symptoms and signs of ADHD include inattention impulsivity hyperactivity The lack of concentration is evident when a child gets a task that requires vigilance, quick response, spatial perception and directional hearing. Impulsivity refers to urgent actions (to cross, for example, in children, a street without looking, in adolescents and adults, sudden leaving school or job without reconsider the consequences of) the potential for a negative result have. Hyperactivity includes excessive motor activity. Children, especially younger ones, may find it difficult to sit still when it is expected of them (at school or church, for example). Elderly patients may be-sometimes just fidgety, restless or talkative to the extent that others feel exhausted when they watch them. Inattention and impulsivity impede the development of higher brain functions, thinking and strategies, motivation for school and adapt to social demands. Children who have primarily the type of "inattentive" ADHD tend to learn by doing. They have difficulty with passive learning, which requires a long-lasting performance and achievement of the object. Overall, about 20-60% of children with ADHD learning disabilities, but some form of school difficulty, every child with ADHD due to inattention (leading to the failure of details) and impulsivity (leading to answer a question without first thinking). A behavioral history can frustration intolerance, uncover oppositional behavior, temper tantrums, aggression, lack of social behavior and lack of peer relationships, sleep disorders, anxiety, despair, depression and changing moods. While there is no specific physical examination or laboratory findings of this disorder, but the symptoms associated with ADHD include: Motor incoordination or clumsiness Nonlocalized, "soft" neurological findings perceptual motor disorders Diagnosis Clinical criteria are based on the DSM-5 the diagnosis is made clinically and is based on the comprehensive medical, developmental, educational and psychological assessments. (See ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention Deficit / Hyperactivity Disorder in Children and Adolescents). DSM-5 diagnostic criteria for ADHD to the diagnostic criteria of the DSM-5 include 9 symptoms and signs of inattention and 9 of hyperactivity and impulsivity. The diagnosis, which use such criteria requires that ? 6 Symptoms and signs of at least one group can often be present for ? 6 months are clearly visible to a greater degree than can otherwise be expected for the child's age kicking in at least two situations (. eg home and school) Show up before the age of 12 (at least some symptoms) troublemakers at home, at school or at work Unaufmerksamkeitssymptome: is not pay attention to details or makes careless mistakes in schoolwork or other activities Has difficulty seems to remain alert for tasks at school or while playing a longer period not to listen when spoken directly follow the instructions or not does not bring to an end tasks has Schwier Avoids organize CANDIES, tasks and activities or loathed or hesitates when it comes to tasks that require increased mental effort for a long time. Loses things necessary for school assignments or activities Is easily distracted Is forgetful in daily activities Hyperactivity and impulsivity: fidgets often overcome with hands or feet or can not stay long time sitting on the chair runs often about or climbs excessively where such an activity is not appropriate has difficulty playing quietly is constantly in motion, as driven by a motor much bursts Speaks often excessively often with the answer out before the interrogative sentence is completed often has to wait for trouble until it's turn is often interrupts others or bother them the diagnosis of Unaufmerksamkeitstypus requires the presence of ? 6 of the criteria for inattention. The diagnosis of hyperactivity / Impulsivitäts-type requires ? 6 symptoms of hyperactivity or impulsivity. The diagnosis of the combined type requires ? 6 symptoms of hyperactivity and Unaufmerksamkeitskriterien Impulsivitäts-Kriterien.Andere diagnostic considerations It is sometimes difficult to distinguish ADHD from other disorders. A hasty diagnosis should be avoided. A clean distinction from other disorders is essential. Many ADHD symptoms in the preschool years may be communication problems with other developmental disorders of the nervous system (eg. As autism spectrum disorders), or in certain learning disorders, anxiety, depression or behavioral problems occur. Physicians should consider whether the child by external factors (environmental) or internal factors (thoughts, fears, concerns) is deflected. In later childhood, however, the ADHD symptoms are apparent. These children often show continuous movements of the lower limbs, motor restlessness (fumbling and motor restlessness), impulsive verbal fluency and apparent lack of awareness of their environment. Children with Unaufmersamkeitsstörung may have no physical signs. The medical assessment includes causes that contribute to these conditions or worsen them. Part of the assessment should the search for earlier prenatal exposures (e. As drugs, alcohol, tobacco) to perinatal complications or infections, CNS infections, traumatic brain injury, heart disease, sleep-disordered breathing, loss of appetite and / or pingeligem food and a family history of ADHD. Neurodevelopmental investigation focused on the transaction and the progression of symptoms. The evaluation includes reviewing milestones of development, especially milestones of language and the use of ADHD-specific rating scales (eg. As the Vanderbilt Assessment Scale the Conners Comprehensive Behavior Rating Scale, the ADHD- rating scale IV). The education history notes especially the cardinal symptoms. This may require access to old school records, but also the use of master plans and checklists. often alone but both help not going to distinguish ADHD from a developmental disorder or a behavioral disorder. The prognosis traditional classroom and most school activities exacerbate the problems of untreated or inadequately treated children with ADHD. Social and emotional adjustment problems may be persistent. Lack of acceptance by peers and loneliness seem to be getting worse with increasing age and the symptoms. Substance abuse can be the result, when the ADHD is not detected and treated adequately, because many young people and adults to self medicate with this disorder: both legal substances (. Eg caffeine) as well as illegal (eg cocaine.) , Although the hyperactivity tends to decrease with age, may remain in adolescents or adults residual symptoms. Predictors of poor outcomes in adolescence and adulthood are low intelligence aggressiveness social and interpersonal problems Parental Psychopathology problems in adolescence and adulthood are particularly evident in the school failure, in low self-esteem and difficulty learning appropriate social behavior. This is reflected in a lack of self-control, restlessness and poor social skills. Youth and adults with a mainly impulsive behavior tend to increased personality disorders and antisocial behavior. People with ADHD seem to be able to adapt better in the workplace than at home or in training, especially when they take jobs that do not require high concentration. Treatment behavioral therapy Drug therapy, usually with stimulants such as methylphenidate or dextroamphetamine (in short- and long-acting preparations) Randomized controlled trials have shown that a sole behavioral therapy cuts worse than a sole treatment with stimulants. A combination of both is recommended for smaller children. Although the underlying neurophysiological changes associated with stimulant medication can not be corrected, the drugs reduce the symptoms of ADHD and allow the children to participate in activities that were not possible for him recently because of the existing lack of attention and impulsivity. The drugs often interrupt the inadequate social behavior, improve school performance, stabilize the behavior, motivation and self-esteem. Treatment of adults follows the same guidelines, an exact dosage depends on the individual criteria and other associated medical conditions. Most stimulants stimulants used include methylphenidate or amphetamine salts. The effect varies greatly, and the amount depends on the severity of the behavioral disorder and tolerability of the drug from the child. Frequency and amount of dosage will be adjusted so that the optimum effect is achieved. Methylphenidate is unretardiert normally with 0.3 mg / kg once daily p.o. started (immediate-release) and increased weekly in the frequency, usually up to 3 times a day or every 4 hours. If the effect is insufficient, but the drug is well tolerated, the dose may be increased. Most children achieve an optimal balance between benefits and side effects in individual doses between 0.3 and 0.6 mg / kg. The Dextro-isomer of methylphenidate, the active unit and is available for a recipe for a half dose. With dextroamphetamine is usually (often in combination with racemic amphetamine) at 0.15-0.2 mg / kg p.o. started once a day. The dosage may then 2 or 3 times a day or every 4 hours can be increased. Single doses of from 0.15 to 0.4 mg / kg are generally effective. When dosing effects and side effects should be taken into account. Generally, the dosage of dextroamphetamine is two-thirds of the Methylphenidatdosis. If the best effective dose is reached for both drugs, it is then administered in a retarded form, so that the children have to take tablets during school hours. Long-acting preparations include wax matrix prolonged release, biphasic capsules, which are the equivalent of 2 doses, osmotic tablets with prolonged effect and transdermal patches, which have a duration of action of up to 12 h. Both short and long-acting liquid preparations are available. Dextro pure preparations (. Dextromethylphenidat for example) are often used to minimize side effects such as anxiety; the dosage is usually half the preparation mixtures. Prodrugs are sometimes used because they are superior in terms of drug delivery, duration of action, side effects. Also, the risk of dependency is lower. Learning is enhanced even at low levels, behavioral changes often make higher amounts required. The dosage can be adjusted to the school or work day (eg., During school or with their homework at home). A pause drugs should be tried on weekends, holidays and during the holidays. A placebo application through 5-10 school days should be carried out to ensure the reliability of the observations and to review the need for medication. Among the common side effects of stimulants include insomnia (z. B. insomnia) depression headache abdominal pain loss of appetite Increased heart rate and high blood pressure in some studies, a growth delay was observed in an application over 2 years. However, the studies are not entirely clear, and it is also unclear whether this delay effect persists for longer periods of taking or not. In most cases, it helps to reduce the dose or to use another drug. Some patients who are sensitive to stimulants can, steamed or exaggerated adapted erscheinen.nichtstimulierende drugs also Atomoxetine, a selective norepinephrine reuptake inhibitor, is used. The treatment is successful, even if the data are compared to the stimulants is not uniform. Vomiting, sedation, irritability and outbursts of anger are a common side effect in children. Rare occurrence, a severe hepatitis or a suicide attempt. The starting dose is 0.5 mg / kg p.o. once a day with an increase for a few weeks up to 1.2 to 1.4 mg / kg once daily. The long half-life allows for once-daily dosing. The maximum dose per day recommended is 100 mg. Antidepressants such as bupropion, alpha-2 agonists such as clonidine and Guangacin and other psychotropic drugs are sometimes used in ineffectiveness of stimulants or massive side effects. but they are not as effective and no drug of first choice. Sometimes these drugs are used in combination with stimulants for synergies; Frequent monitoring for side effects unerlässlich.Verhaltensmaßnahmen A consultation including behavioral therapy (objective introspection, behavioral change, role play) is very successful and helps the child to understand the ADHD. Also necessary structures and routines is set. The behavior in the classroom can often be improved by reducing the noise level and visual stimuli, an appropriate task length, tutor, new approaches and the proximity of the teacher. If you experience difficulty at home, the parents should be encouraged to seek professional help for training in methods for behavioral change. Methods with reward incentives reinforce behavioral changes and are very effective. Children with ADHD in which hyperactivity and low self-control prevail, is often characterized helped that the day is well organized at home, there are defined limits and the reactions of parents to certain behavior are always constant. Treatment with elimination diets, multivitamins, the use of antioxidants and other remedies and dietary changes or biochemical agents have the lowest detectable success. Biofeedback may be helpful in some cases, but is not recommended for routine use, as evidence of lasting benefits are missing. Summary ADHD includes inattention, hyperactivity / impulsivity, or a combination, it usually appears before the age of 12 years and in children who start school earlier. The cause is unknown, but there are numerous putative risk factors. The diagnosis should be based on clinical criteria. While other diseases have to be considered, which manifest themselves similarly (z. B. autism spectrum disorders, specific learning or behavioral problems, anxiety or depression). Although the hyperactivity decreases with age, as a rule, can remain in adolescents or adults residual symptoms. is treated with stimulants and cognitive behavioral therapy. Behavioral therapy alone is recommended for preschoolers. References American Academy of Pediatrics: ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention Deficit / Hyperactivity Disorder in Children and Adolescents National Institute for Children's Health Quality

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