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Deficit
Hyperactive
Disorder
(ADHD)
Kevin Lukito
112017040
Pembimbing:
– Genetic factor
– Mutation of neurotransmitter coding gene and Dopamine receptor (D2 and D4) in
chromosome 11p
– Monozygote twins > dizygote twins
– Siblings of child with ADHD have 5-7 times higher risk
– Children with ADHD parents have 50% probability
– Brain injury
– It is assumed that children with ADHD have a history of minor brain injury in the fetus and
prenatal period.
– Brain injury might be caused by toxin, metabolic, mechanical, stress and physical defect in
the brain which are caused by infection, inflammation and trauma
– Neurochemical factor
– Dysfunction in adrenergic and dopaminergic system
– Anatomic structure
– PET (Positron Emission Tomography) found decrease in serebral circulation and speed
of metabolism in frontal lobe of children with ADHD.
– Brain imaging found meaningful brain volume decrease in prefrontal cortex, right
caudal nucelus, right globus pallidus and vermis (part of cerebellum).
– The function of these parts of the brain is to regulate a person’s attention function.
Patophysiology
– Hyperactivity
– Motoric disorder
– Emotional lability
– Coordination deficit
– Attention problem
– Impulsivity
– Memory problem
– Learning disability
– Talking and listening problem
Diagnostic Criteria based on
DSM-IV
– Either one (1) or (2):
1. Inattention 6 (or more) inattention symptomps stays for at least 6 months until maladaptive stage and
inconsistent with development stage:
– Often fails to give attention to details or make a careless mistake in school work, work or other activity.
– Often has difficulty in staying focus for work or game activity.
– Often look like the child is not listening while people are talking.
– Often not follow instruction and fail to finish school work, work or obligation at work (not because the child doesn’t
understand the instruction)
– Often has difficulty in arranging work and activities.
– Often avoid, hate or don’t want to be involved in activity that requires long mental work.
– Often avoid things that are needed for work or activity.
– Often easily distacted by outside stimulants.
– Often forget things in daily activity.
– Hyperactivity-impulsiveness 6 (or more) inattention symptomps stays for at
least 6 months until maladaptive stage and inconsistent with development
stage
– Hyperactivity
– Often anxious with hands and feet or squirming at the seat.
– Often leave his/her seat in the class or other situation where the child needs to remain
seated.
– Often run around or climb excessively in inappropriate situation.
– Often has difficulty in playing or involved in free time activity.
– Often talk excessively.
– Impulsivity
– Often answers without thinking even before the question is finished.
– Often has difficulty in queue-ing or disturbing other people.
– Often interrupts or disturbing other people.
– Some hyperactive-impulsive or inattention symptoms have been there before the
age of 7.
– Some disorders caused by symptoms are there in 2 or more situations (ex: at school,
work and home)
– Definite proof of disorders must be there in social function, academic or work.
– The symptoms are not caused by other mental problems and are not defined better
by other mental disorder.
Supporting Examination
– Laboratorium test
– For substance abuse
– Radiology test
– Found decrease in circulation of frontal lobe.
– Other test
– Child Behaviour Check List atau Behavior Assessment System for Children to find
other disorder in a child.
– Learning disability evaluation (intelligence {IQ} vs achievement)
Differential Diagnosis
– Neurologic disorder
– Tourette syndrome
– Hearing problem
– Psychiatric disorder
– Adaptation disorder
– Mental retardation
– Behaviour problem
Therapy
– Pharmacotherapy
– Stimulants:
– Methylphenidate age ≥ 6 y.o
– Dexamphetamine age ≥ 3 y.o
– Atomoxetine
– Tricycline Antidepressants (TCAs)
– Imipramine, amitriptyline and clomipramine
– Other drugs
– Clonidine
– Behavioural therapy
– Focused on identifying behaviour problems and trying to change the behaviour to
desired result.
Prevention
– There are no definite way to prevent ADHD, but there are ways to prevent the
problems that might cause or be caused by ADHD.
– Avoid toxins
– Protect child from pollutants and toxins
– Always consistent
– Arrange routine schedule with the child
– Avoid multitasking when talking with the child
– Work together with teacher and guardian to identify the problems as early as
possible
Prognosis
Usually stays if family
history (+), negative
events in life,
Persistent (40-50%) comorbidity with
behaviour symptoms,
depression and anxiety
disorder
ADHD
Total remission
Remission (50%)
Partial remission
ADHD Impact in Child’s Development
Behaviour problem Academic difficulty Job failure
Bad socialization Interpersonal relationship problem
Self image problem
Trauma or injury risk
Law breaking
Smoking