21 Januari 2010


Dr. Rismarini, SpA
Description of the problem :
ADHD is a behavioral syndrome that appears early in the child life, typically persist throughout childhood and adolescence.

The defining behaviors fall under the general catagories of :
- hyperactivity,
- inattentiveness, and
- impulsivity
Epidemiology :
4 – 6% of elementary school-aged children
Up to 20 % in lower socioeconomic status
Male to female ratio = 6 : 1
Etiology : ?
There are multiple causes :
Genetic factors
Differences in the brain (neuroanatamy & neurotransmiters)
Environmental factors :
 Parental psychopathology,
Low socioeconomic status,
Poor monitoring of behavior,
A punitive approach to discipline
Diagnostic criteria
Inattention or hyperactivity-impulsivity
Some symptoms that caused impairments were present < age 7 yr
Impairment are present in > 2 setting
Clinically significant impairment in social, academic or accupational
Doesn’t occur during the course of a pervasive disorder, schizophrenia or other psychotic disorder

1. Inattention
At least six symptoms of inattetion, persisted at least 6 months,
That is maladaptive and inconsistent with developmental level
Often fails to give close attention to details, makes careless mistaken in schoolwork, work and other activity
Often has difficulty sustaining attention in tasks or play activity
Often doesn’t seem to listen
Often doesn’t follow through on instruction and fail to finish schoolwork, chores, or duties
Often has difficulties organizing tasks and activity
Often avoids, expresses reluctance about, or has diffuculties engaging in tasks
Often loses things necessary for tasks or activity
Often easily distructed by extraneous stimuli
Often forgetful in daily activities
2. Hyperactivity-impulsivity
At least 5 simptoms of hiperactivity-impulsivity, persisted for at least 6 months
That is maladaptive ans inconsistent with developmental level
Often fidgets with hands or feet or squirms in seat
Leaves seat in classroom or in other situations
Often runs about or climbs excessively
Often has difficulty playing or engaging in leisure activity quietly
Is always “on the go” or act as if “driven by a motor”
Often talks excessively

Often blurts out answers to questions before the questions have beeb completed
Often has difficulty waiting in lines or awaiting turn in games or group situations
Often interrupts or intrudes on others
Clasification :
ADHD predominantly inattentive type
ADHD predominnantly hyperactive–impulsive type
ADHD combined type
Differential diagnosis
Pervasive developmental disorder (autisme, autistic-like disorder)
Major affective disorder (depression)
Reaction to stress
Iron deficiency anemia
Lead toxicity
Hearing loss
1.Medication : CNS stimulant
Methylphenidate 0,3 mg/kg/dose, twice daily, increase by 0,15 mg/kg/dose
Dextroamphetamine 0,15 mg/kg/dose, twice daily, increase by 0,15 mg/kg/dose
Pemoline 37,5 mg in AM
Psychological therapy
Teaching effective behavioral management skills to parents & teachers
Child and parent counseling
Group social skills training
Family therapy, dinamic
Family therapy, communication skills
Child psychotherapy

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