Attention-deficit and disruptive behavior disorders

Disorders of infancy, childhood, or adolescence

Clinicals - History

Fact Explanation
Introduction These are neurobehavioural disorders of childhood and adolescence which may or may not prevail in adulthood. The characteristic symptoms are inattention, impulsivity and hyperactivity. The pathophysiology is attributed to abnormalities in neurobiological mechanisms in the frontal and striatal regions of brain which affect executive function. The differentiation between the disorder and normal behaviour is done in comparison to norms for age and IQ. These behaviour differences should be present in different settings. Introduction
These are neurobehavioural disorders of childhood and adolescence which may or may not prevail in adulthood. The characteristic symptoms are inattention, impulsivity and hyperactivity. The pathophysiology is attributed to abnormalities in neurobiological mechanisms in the frontal and striatal regions of brain which affect executive function. The differentiation between the disorder and normal behaviour is done in comparison to norms for age and IQ. These behaviour differences should be present in different settings.
Impaired attention This is on of the two cardinal features required for diagnosis and has to be evident in more than one situation(home, school etc.). These children frequently change from one activity to another leaving activities unfinished. They seem to break off from one task, losing interest as they get diverted to another. Impaired attention
This is on of the two cardinal features required for diagnosis and has to be evident in more than one situation(home, school etc.). These children frequently change from one activity to another leaving activities unfinished. They seem to break off from one task, losing interest as they get diverted to another.
Overactivity This is the other feature necessary for the diagnosis and should also be evident in more than one situation. The child is excessive restlessness, especially in situations requiring relative calm. Judgement is made in comparison with behavior of other children of the same age and IQ. The child may be running and jumping around, getting up from a seat when he or she was supposed to remain seated. Excessive talkativeness and noisiness, or fidgeting and wriggling is also seen. Overactivity
This is the other feature necessary for the diagnosis and should also be evident in more than one situation. The child is excessive restlessness, especially in situations requiring relative calm. Judgement is made in comparison with behavior of other children of the same age and IQ. The child may be running and jumping around, getting up from a seat when he or she was supposed to remain seated. Excessive talkativeness and noisiness, or fidgeting and wriggling is also seen.
Recklessness These children are often impulsive and reckless, prone to accidents. They frequently get in to disciplinary trouble because they unthinkingly breach of rules. They intrude on or interrupt others' activities. Answer questions prematurely before they have been completed. They have difficulty in waiting turns. Recklessness
These children are often impulsive and reckless, prone to accidents. They frequently get in to disciplinary trouble because they unthinkingly breach of rules. They intrude on or interrupt others' activities. Answer questions prematurely before they have been completed. They have difficulty in waiting turns.
Socially disinhibition These children lack the normal caution and reserve. Their relationships with adults are often socially disinhibited but they are unpopular with other children and may be isolated. Socially disinhibition
These children lack the normal caution and reserve. Their relationships with adults are often socially disinhibited but they are unpopular with other children and may be isolated.
Age This disorder usually arise in the first five years of life, early in the child's development. Age
This disorder usually arise in the first five years of life, early in the child's development.
Family history Some studies suggest of a genetic susceptibility to develop this disorder.Therefore it is important to determine the presence of a first or second degree relative with similar condition. Family history
Some studies suggest of a genetic susceptibility to develop this disorder.Therefore it is important to determine the presence of a first or second degree relative with similar condition.
Antenatal history Use of tobacco, alcohol, caffeine, and certain psychotropic medication by the mother during pregnancy, poor maternal nutrition, maternal stress during pregnancy,maternal gestational diabetes and exposure to lead or mercury have shown to increase risk of developing these disorders. Antenatal history
Use of tobacco, alcohol, caffeine, and certain psychotropic medication by the mother during pregnancy, poor maternal nutrition, maternal stress during pregnancy,maternal gestational diabetes and exposure to lead or mercury have shown to increase risk of developing these disorders.
Social history Social factors such as poor parenting, parental conflicts, home discord, low socioeconomic status, institutionalized care, exposure to violence and trauma etc. have shown to increase the risk of developing attention-deficit and disruptive behavior disorders. Social history
Social factors such as poor parenting, parental conflicts, home discord, low socioeconomic status, institutionalized care, exposure to violence and trauma etc. have shown to increase the risk of developing attention-deficit and disruptive behavior disorders.

Clinicals - Examination

Fact Explanation
Mental state examination There will be no significant clinical findings on physical examination. Mental state examination may reveal some important factors. These children will appear to be fidgety, impulsive. They usually are unable to sit still and run around the office. Mood will be congruent and euthymic or slightly elevated, but not euphoric. They may have low self-esteem. They can be easily irritable. Speech may be at normal rate or rapid and louder. May have difficulties in staying on one topic. There will be no hallucinations or delusions present. Thought content should be normal, with no suicidal/homicidal ideas. Attention, concentration and recent memory are affected but orientation, remote memory are normal. Mental state examination
There will be no significant clinical findings on physical examination. Mental state examination may reveal some important factors. These children will appear to be fidgety, impulsive. They usually are unable to sit still and run around the office. Mood will be congruent and euthymic or slightly elevated, but not euphoric. They may have low self-esteem. They can be easily irritable. Speech may be at normal rate or rapid and louder. May have difficulties in staying on one topic. There will be no hallucinations or delusions present. Thought content should be normal, with no suicidal/homicidal ideas. Attention, concentration and recent memory are affected but orientation, remote memory are normal.

Investigations - Diagnosis

Fact Explanation
The Conners Parent-Teacher Rating Scale The diagnosis of these disorders is based on the history. This is a scale or a test in the form of a questionnaire about the behavior of the child that helps in the diagnosis. This is given to parents and teachers so that a comprehensive inventory about the child's behavior can be made and the psychiatrist evaluating the child can gain a full understanding about the behaviors and habits. This can also be used in the follow up after initiating treatment. The Conners Parent-Teacher Rating Scale
The diagnosis of these disorders is based on the history. This is a scale or a test in the form of a questionnaire about the behavior of the child that helps in the diagnosis. This is given to parents and teachers so that a comprehensive inventory about the child's behavior can be made and the psychiatrist evaluating the child can gain a full understanding about the behaviors and habits. This can also be used in the follow up after initiating treatment.

Investigations - Management

Fact Explanation
Electrocardiogram Done in children receiving stimulunt medication as they can cause arrhythmias. Electrocardiogram
Done in children receiving stimulunt medication as they can cause arrhythmias.
Liver function tests Done to assess baseline liver function because most of the drugs used for treatment are metabolized by the liver Liver function tests
Done to assess baseline liver function because most of the drugs used for treatment are metabolized by the liver
Vision testing Done to detect comorbid visual problems associated with this condition. Vision testing
Done to detect comorbid visual problems associated with this condition.
Hearing testing Done to detect problems with auditory functioning that can be associated wih this condition. Hearing testing
Done to detect problems with auditory functioning that can be associated wih this condition.

Management - Supportive

Fact Explanation
Educating family, care givers and teachers The family, care givers and teachers should educated on the nature of the disease, available treatment, possible co-morbidities, prognosis etc. These children requires to work according to a schedule. They should be encouraged to work according to a time table every day. Same routine daily from wake-up time to bedtime with specific times for homework, outdoor play, meals etc. Everyday items should be kept in a well organized manner. The child should be encouraged to keep the items in place after use. Be clear and consistent with rules that are placed. Child should be praised and given rewards when rules are followed and work done as scheduled. These are some of the easy measures that can be taken. Educating family, care givers and teachers
The family, care givers and teachers should educated on the nature of the disease, available treatment, possible co-morbidities, prognosis etc. These children requires to work according to a schedule. They should be encouraged to work according to a time table every day. Same routine daily from wake-up time to bedtime with specific times for homework, outdoor play, meals etc. Everyday items should be kept in a well organized manner. The child should be encouraged to keep the items in place after use. Be clear and consistent with rules that are placed. Child should be praised and given rewards when rules are followed and work done as scheduled. These are some of the easy measures that can be taken.

Management - Specific

Fact Explanation
Methylphenidate This is the most frequently prescribed psychostimulant. It is available in both short- and long-acting or extended-release formulations. It can help sustain attention, impulse and emotional control, reduction of task-irrelevant activity, diminishment of disruptive behavior, and aggression. This helps in compliance with behavior treatment. Methylphenidate
This is the most frequently prescribed psychostimulant. It is available in both short- and long-acting or extended-release formulations. It can help sustain attention, impulse and emotional control, reduction of task-irrelevant activity, diminishment of disruptive behavior, and aggression. This helps in compliance with behavior treatment.
Atomoxetine This is a selective norepinephrine reuptake inhibitor, considered as second line treatment. It has shown to improve symptoms and help in compliance with behavior therapy. Atomoxetine
This is a selective norepinephrine reuptake inhibitor, considered as second line treatment. It has shown to improve symptoms and help in compliance with behavior therapy.
Tricyclic antidepressants Such as imipramine has shown to improve symptoms in children but are not commonly used due to their adverse event profile. Tricyclic antidepressants
Such as imipramine has shown to improve symptoms in children but are not commonly used due to their adverse event profile.
Behavioral psychotherapy Is shown to be most effective when used together with effective medication. This involves working with parents, teachers and care givers to create an environment which encourages appropriate behavior and focus. Behavioral psychotherapy
Is shown to be most effective when used together with effective medication. This involves working with parents, teachers and care givers to create an environment which encourages appropriate behavior and focus.

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