Attention Deficit Hyperactivity Disorder - Part II
School problems and the Family Physician
Dr. Latha Ravichandran, DCH, DNB(Pediatric Medicine)
Attention deficit Hyperactivity disorder (ADHD) is the most common behaviour problem that interferes with the child’s functioning at school. It is characterized by developmentally inappropriate degrees of inattention and impulsiveness, with or without hyperactivity. ADHD affects 3-5% of the school age children.
ADHD is defined as an impulsive behaviour that is present before the age seven, with symptoms observed for at least 6 months and in at least 2 sittings.Diagnostic criteria :
Diagnostic Criteria for Attention Deficit Hyperactivity Disorder - Table 1
A.Either 1 or 2:
- Six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- Often has difficulty sustaining attention in 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 wor kplace not due to oppositional behavior or failure to understand instructions
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort, such as schoolwork or homework
- Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
- Six or more of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:Hyperactivity
- Often fidgets with hands or feet or squirms in seat
- Often leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- Often has difficulty playing or engaging in leisure activities quietly
- Is often on the go or often acts as if driven by a motor
- Often talks excessively Impulsivity
- Often blurts out answers before questions have been completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that cause impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school or work and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).
Role of Family Physician in ADHD
The role of family physician is to :
medical causes of hyperactivity such as hyper thyroidism
To diagnose ADHD and refer patients for appropriate management (to psychologists & to psychiatrists)
Decide the medical management of ADHD in addition to educational and behavioural interventions.
Be aware of the commonly used medica-tions, the standard monitoring guidelines for these drugs and their adverse effects.