Improve Listening Skills in ADHD Children

How To Conquer Add / Adhd

Number 1 Guide On How To Cope With Attention Deficit Disorder, Add Adhd. Inside this research collection, you will: Learn about Add / Adhd in Laymens Terms and find out more about the Keys to Success in dealing with the disorder. Cut to the chase reading. No wasting your time, your money and your patience. Arm yourself with knowledge about the causes and symptoms of Add / Adhd, in children and in adults. And find out where to go for testing and a diagnosis. Take action now to get started on the Success Path instead of plodding along on the Ignorance Trail. Uncover specific ways to help children (yours or someone elses) who have been diagnosed with Add / Adhd. Use our handy resources, network, learn more ways and get more help. Tailor strategies that work for Both you and the child. Read overviews about many successful treatment strategies along with detailed information about how to pinpoint specific options available in Your area (i.e. where You live). No more waiting to find out who can help or where to go. Print out our basic questions to ask when you are trying to learn more about Add / Adhd so that you can keep a journal of handy information for follow up reference and quick help along the way. Save money, time, aggravation, stress, hair from being pulled out, and much moreby Printing out and using our, How to Set Up and Use Organizer & Filing Systems, step-by-step action plan. Fill your notebook with your own planner sheets downloaded from our resource section and use them Now! No more waiting for a better day. Its here and its time to get organized. Continue reading...

How To Conquer Add Adhd Summary


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Attentiondeficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is one of the most thoroughly studied disorders in child psychiatry, and the increasingly common use of stimulant drugs to treat this disorder has become the focus of much public attention and debate in recent years. ( 3) ADHD is defined in terms of three key features lack of sustained attention, impulsivity, and hyperactivity. According to the earlier DSM-III diagnostic definition, ADHD affects approximately 5 per cent of all school-age children. However, the DSM-IV definition includes subcategories (e.g. primarily inattentive), and the diagnosis of ADHD now includes more than 10 per cent of children. (1415) Because of the interest in the drug treatment of ADHD, a number of assessment tools have been developed. These include the widely used Conners Teacher Rating Scale, the Conners Parent Rating Scale, and a variety of tests designed to measure hyperactivity, problem behaviour, attention, and other aspects of cognition, as well as...

Specific psychopathological disorders in children with mental retardation Behavioural disorders Attentiondeficit

The diagnostic criteria in ICD-10 and DSM-IV are relatively straightforward to apply in children with mental retardation because they are based on observable behaviours such as distractability and fidgeting, rather than verbal reports of perceptions and emotions. However, diagnostic difficulty may be encountered in determining if the observed behaviour is 'inconsistent' with the developmental level of the child. (7) For example the attention span of a 9-year-old child with moderate mental retardation is likely to be similar to that of a 3-year-old child without mental retardation. According to DSM-IV the diagnosis of AdHd should not be made in a child with a pervasive developmental disorder. However, there is some research to indicate that a comorbid diagnosis of ADHD can be made in some children with autism and that, in these cases, there may be a therapeutic response to stimulant medication.(57) Symptoms of ADHD are required to be present in at least two settings such as at home and...

DSMIV 31400 Diagnostic criteria for Attention DeficitHyperactivity Disorder

Code based on type 314.01 Attention-Deficit Hyperactivity Disorder, Combined Type if both Criteria A1 and A2 are met for the past 6 months Disorder, Predominantly Inattentive Type if Criterion A1 is met but Criterion A2 is not met for the past 6 months Disorder, Predominantly Hyperactive -Impulsive Type if Criterion A2 is met but Criterion A1 is not met for the past 6 months

Head injury in children

Children often sustain a bilateral prefrontal injury, which may explain the deficits in concentration, controlling impulsivity, and self-monitoring. The commonest psychiatric disorders that follow childhood head injuries are personality changes, attention-deficit hyperactivity disorder, and obsessive-compulsive disorder. (62 Children who develop attention-deficit hyperactivity disorder after head injury tend to demonstrate less hyperactivity than is seen in the idiopathic form of this disorder. In the long term the head-injured child may be at increased risk of developing schizophrenia. Children are more likely to develop post-traumatic epilepsy than adults.

Special Risk Factor

There seems to be an important subgroup of the childhood-onset cohort that are at special risk for developing adult problems. Although the theoretical underpinnings of why ADHD, ODD, CD in childhood, and APD in adulthood are related is yet unclear, there is substantial empirical support to suggest that they are. Lahey and Loeber (1997), drawing on 30 years of empirical literature exploring these relationships, cite several lines of research that help explicate the connections between these childhood disorders and adult antisocial behavior. The first is the well-supported finding that children with ADHD are more likely to display antisocial behavior as adolescents and adults than are children without ADHD. A second involves the relatively poor prognosis for children who have concurrent ADHD and CD. Those who meet criteria for both have higher rates of CD over time than for those with CD alone. Less is known about the ways that ODD is linked to CD and later adult antisocial behavior,...

Psychiatric comorbidity

Several studies have found that 70 per cent of addicts meet diagnostic criteria for a current psychiatric disorder, frequently depression, antisocial personality, and alcohol dependency 5,1.6) Such diagnoses may be primary or secondary to opiate abuse, and a careful assessment of mental state and social functioning when opiate free should be performed. Many will have had childhood behavioural problems such as conduct disorder, and studies suggest that attention-deficit hyperactivity disorder, truanting, and juvenile offending are markers for subsequent use. (1D Clearly, comorbid psychiatric disorders should be treated in their own right especially if it is felt that they are important in maintaining opiate use. (18) Opiate dependence is also a strong risk factor for suicide, which accounts for up to a third of all deaths among intravenous drug users.(,19)

And now a bit more about

Attention Deficit, Hyperactivity Disorder. As much as I can understand why it has been given such a title, it does seem slightly inaccurate. Joe doesn't seem to have a deficit at all but rather an overload The overload may certainly result in an inability to concentrate and attend, and so seems like a deficit, but in reality he has too many thoughts in his head, too many ideas, too much energy.

Neurological Disorders and Neurodegenerative Diseases

The dose-dependent and complete blockade of amphetamine-induced increases in locomotor activity by the H3 antagonists thioperamide and ciproxifan suggest a potential use of H3 antagonists in schizopherina. However, since levels of tele-methylhistamine (a marker to measure the activity of the histamine turnover) have been found to increase in schizophrenic-like symptomatology, increases in histamine levels with H3 antagonists may be contradicted. Yet, it may well have efficacy in the treatment of some symptoms of schizophrenia (e.g. congnition). Two further neurological disorders cataplexy and attention deficit hyperactivity disorder (ADHD) have come into focus as putative candidates for H3 receptor antagonistic treatment. Due to the arousal and sleep-controlling nature of histamine and the relationship of this neurotransmitter to the arou

The 5Choice Serial Reaction Time Task A Introduction

An impressive series of studies over the last ten years employed a variety of drug and lesion challenges to characterize the roles of the ascending monoaminergic arousal systems in performance of this task (reviewed by Robbins and Everitt, 1995). In addition, it has been proposed as a means to model attention deficit hyperactivity disorder in rats (Puumala et al., 1996) and to evaluate the effects of lesions (Muir et al., 1996) and systemic drugs (Jones and Higgins, 1995 Jakala et al., 1992a 1992b) on performance of the task. In general, accuracy of responding on the basic task appears to depend upon cortical acetylcholine and speed of responding on mesolimbic dopamine. Auditory distractors are particularly disruptive to rats with loss of ceruleocortical norepinephrine, and adequate forebrain serotonin appears to be necessary to suppress premature responding (Robbins and Everitt, 1995).

Performance Deficits By Nicotinic Drugs

Attention deficit hyperactivity disorder (ADHD) is among the most prevalent of childhood and adolescent disorders, accounting for up to 50 of clinic visits in these populations. The predominant characteristics of ADHD, inattention and dis-tractibility, are also among the symptoms associated with prenatal and early postnatal exposure to a variety of toxicants, as well as with a wide variety of neurologic and psychiatric disorders including AD, Parkinson's disease, Huntington's disease, Tourettes syndrome, and schizophrenia. The primary therapeutic agents utilized for ADHD and other disorders where distractibility and inattention are prominent features include methylphenidate, dextroamphetamine, mixed amphetamine isomers, and pemoline. While the efficacy of these agents has been demonstrated, they are also associated with a wide variety of adverse effects including insomnia, decreased Nicotine has been shown in a number of studies to enhance arousal, visual attention, and perception and...

Chapter References

Pharmacotherapy of adolescent attention deficit hyperactivity disorder challenges, choices and caveats. Journal of Psychopharmacology, 12, 385-3. 15. Sagvolden, T. and Sergeant, J.A. (1998). Attention deficit hyperactivity disorder from brain dysfunctions to behaviour. Behavioural Brain Research, 94, 1-10. 17. Solanto, M.V. (1998). Neuropsychopharmacological mechanism of stimulant drug action in attention-deficit hyperactivity disorder a review and integration. Behavioural Brain Research, 94, 127-52.

Treatment and response

States, African-American children have substantially lower rates of receiving methylphenidate. (6 64 Such differences may be related to differences in explanatory models of African-American parents, and differences in the rate with which African-American parents receive appropriate information about attention deficit-hyperactivity disorder from the doctor.(65)

Categories and dimensions

Reducing symptom count to below a particular threshold on a rating scale has long been taken as an indication of successful treatment in, for instance, attention-deficit hyperactivity disorder. There is no logic to say that the methods for reducing a scale score within the clinical range, or reducing the chance of the score increasing across a threshold into a category of disorder, are qualitatively different for one part of a scale than another. They may be more difficult at extremes of severity because of comorbidity or the interplay of risk factors, but they are likely to be the same in kind.

Intervention at an early age

The chronicity of a number of children's mental health problems is now established. Just over half of the 2- to 3-year-old children studied by Lavigne et a .(12) who had a DSM-IIIR diagnosis still had a psychiatric disorder 3 to 4 years later. Continuity was especially high for disruptive disorders. Studies using rating scales rather than diagnoses report the same over longer periods. (18 Maintaining factors can be different from initiating factors. Persistence of a disorder is associated with comorbidity, parenting problems, and family relationship difficulties even when these are not the initial cause. In the Newham study of hyperkinetic and attention-deficit problems for instance, maternal depressive symptoms and high levels of criticism were associated with the persistence (but not the origin) of hyperkinetic disorder. (19) In general, the early presentation of a psychiatric disorder is associated with greater severity and a worse prognosis, something shown clearly for depression,...

The relevance of services

Most children with psychiatric disorder, even the more severe cases, will not be treated by mental health services. In two epidemiological studies conducted in the United Kingdom, none of the cases of hyperkinetic disorder in one(19) or of major depressive disorder in the other(6 were known to specialist services. In part, this is because the volume of such services is historically small. But accessibility, biases in referral, and stigma also limit their use. Generally, attempts have been made to simplify the process of first contact so that this can be provided by community health workers of some type. For instance, Davis and Spurr(27) showed how community health visitors trained in child mental health issues could reduce parental distress. A wide-ranging survey by the Mental Health Foundation includes a brief report of an uncontrolled study of a London community mental health service for adolescents, the establishment of which has been associated with a one-third reduction in...

Evolution in nomenclature

These labels reflected the existing emphasis on hyperactivity as the cardinal manifestation of the syndrome. (19 The name of the disorder was changed to attention-deficit disorder in the third edition of the Diagnostic and Statistical Manual in 1980(11 to reflect the prevailing opinion, especially in North America, that cognitive deficit rather than overactivity lay at the heart of the disorder. (1,2) Nevertheless, a distinction between those with and those without hyperactivity was retained. In 1987, DSM-IIIR changed the name of the disorder to attention-deficit hyperactivity disorder and combined all symptoms into one unidimensional category, reflecting the then current view that inattention, restlessness, and impulsiveness were related and equivalent markers of the disorder.

Evolution in clinical practice

These differences in diagnostic practice have had a profound impact on estimates of the prevalence of the disorder and its treatment, initiating a debate about the overinclusiveness of the diagnosis that continues today. ( 8) In the United Kingdom, for example, HD was diagnosed in only 0.001 per cent of children during the 1960s,( 9 whereas in North America, ADHD was thought to apply to between 5 and 10 per cent of children.(20) Recent revisions of both North American (DSM-IV)(19 and European (ICD-10)(21 criteria have resulted in a much more unified set of diagnostic criteria, although differences remain (see below for discussion and Table 1).

Relation to other disorders

Conduct disorder is one of the two disruptive disorders of childhood (also known as externalizing disorders) the other is the hyperkinetic syndrome (ICD-10), also known as attention-deficit hyperactivity disorder (DSM-IV). Conduct disorder and the hyperkinetic syndrome are distinct disorders but they often co-occur. As discussed in L9.1 1 on the classification of childhood psychiatric disorders, disruptive disorders can be distinguished on a number of criteria from the other main grouping of child psychiatric conditions, namely the emotional disorders (also known as internalizing disorders). For example, unlike emotional disorders, disruptive disorders are more common in boys, the socially disadvantaged, children from large families, and where there is parental discord.

Other Neurotransmitters

While most neurochemical research has focussed on dopamine and nora-drenaline, other neurotransmitters have been suggested to play a role in ADHD, principally serotonin and adrenaline. Serotonergic involvement in ADHD was suggested because stimulant and antidepressant drugs have serotonergic agonist activity (Mason, 1984 Weizman et al., 1990). However, measures of serotonin metabolites in CSF indicate that serotonergic systems may be normal in children with ADHD (Raskin et al., 1984 Weizman et al., 1990). There is some evidence for a role of adrenergic influences in ADHD (Castellanos, 1997 Pliszka et al., 1996). Deficits in both the central and peripheral adrenergic systems may contribute to excessive locus coeruleus activity in ADHD (Pliszka et al., 1996).

Clinical features Neurodevelopmental disorders

Developmental psychopathology considers child psychopathology from a developmental perspective by applying developmental concepts to neurodevelopmental disorders. Thus, the relationship of disordered to non-disordered behaviour is considered, as are the early origins of maladaptive behaviours that do not appear in clinical form until adulthood. Knowledge of normal development is utilized to study children whose development is atypical, in order to understand the natural history of their disorder. Conversely, investigation of such deviant behaviour is considered in regard to our understanding of normal development. For example, attention-deficit hyperactivity disorder has been investigated as a disorder of executive function, and autistic disorder as a disorder of social cognition and communication. In both instances, new knowledge about brain functions has been derived from these formulations. Among the neurodevelopmental disorders, the age of onset varies, multiple causes are...

Clinical features

Subsequent occurrence of post-traumatic psychiatric symptoms is linked to the severity of the injury, its location, the child's behavioural and emotional features prior to the accident, and the psychosocial interactions of the family members during the recovery phases. The more severe the traumatic brain injury, the greater the likelihood of psychiatric sequelae. All children in one prospective study of severely injured children who had premorbid psychiatric conditions showed post-traumatic psychiatric disorders. k Moreover, over half the children in this group who had no premorbid symptoms prior to the accident had developed psychiatric symptoms during a 28-month, follow-up period. The greatest premorbid risks for psychiatric disorder were previous difficulties with impulse control and disruptive behaviour. In addition, a prior history of family dysfunction increased the risk for later symptomatology. The range of disorders (38,39 and40) includes attention-deficit hyperactivity...

Psychopharmacological interventions

One must be careful about the risk of inducing suicidal ideation or behaviour through psychopharmacological activation or disinhibition. Clinicians should be cautious about prescribing medications that may reduce self-control, such as the benzodiazepines, and phenobarbitone (phenobarbital). These drugs also have a high lethal potential if taken in overdose. Montgomery(48) noted that benzodiazepines may disinhibit some individuals who then become aggressive and attempt suicide and that there are suggestions of similar effects from the antidepressants, maprotiline and amitriptyline, the amphetamines, and phenobarbitone. Amphetamines or other stimulant medication should only be prescribed when treating suicidal children and adolescents with attention-deficit hyperactivity disorder.

Studies of Frontal Lobe Executive Functions

More recently, neuropsychological studies of ADHD have focused on measures of executive functions, or processes thought to involve the frontal lobes of the brain (Pennington & Ozonoff, 1996 Tannock, 1998). Performance deficits on various measures of executive functions have been found in ADHD subjects, using tasks such as the Tower of Hanoi or Tower of London (Aman et al., 1998 Pennington et al., 1993), the Matching Familiar Figures Test (Pennington et al., 1993 Robins, 1992), the Stroop colour-word interference task (Boucugnani & Jones, 1989 Grodzinsky & Diamond, 1992) and the Wisconsin Card Sort Task (Boucugnani & Jones, 1989 Shue & Douglas, 1992). Adults with prefrontal lobe injuries are also found to perform poorly on these same tasks and brain imaging studies have found frontal activation during performance of these tasks, leading to the suggestion that poor performance on executive function tasks by children with ADHD indicates frontal lobe deficits (Barkley, 1997). In their...

Studies of Parietal Lobe Functions

A small number of studies have used neuropsychological tasks to examine parietal lobe function in children with ADHD. The idea of parietal lobe involvement in ADHD arose from observations that children with ADHD and patients with right parietal lobe damage showed similar symptoms of inattention and hypoarousal (Aman et al., 1998 Voeller & Heilman, 1988). Children with ADHD were found to make more errors of omission and more left-sided errors than controls on the Letter Cancellation Task, suggesting deficits similar to those of adults with right hemisphere dysfunction (Voeller & Heilman, 1988). Mental rotation tasks have also shown deficits in children with ADHD (Aman et al., 1998 Snow, 1990), similar to those reported for patients with right parietal lesions (Ditunno & Mann, 1990). The right parietal cortex has been shown to be involved in visuo-spatial attention in PET studies (Corbetta et al., 1993) and in lesion studies (Posner & Raichle, 1994). The pattern of performance exhibited...

Diagnosis and classification

There is controversy and lack of agreement regarding approaches to the classification and description of the phenomenology of psychopathology in young people with mental retardation. One approach is the application of DSM-IV(7) or the ICD-10(8) systems to the findings of a clinical assessment. The reliability and validity of this approach when applied to children with mental retardation has still to be fully established. Many of the diagnostic categories in these systems require information from the young person on their emotions and perceptions such as the experience of persistent intrusive and inappropriate thoughts that cause anxiety in obsessive-compulsive disorder, or the presence of delusions and hallucinations in schizophrenia. Some diagnoses require a judgement that the symptoms are inconsistent with the developmental level of the child as is the case for attention-deficit hyperactivity disorder ( ADHD).(7) These clinical judgements become increasingly difficult, if not...

Pervasive developmental disorders

About 75 to 80 per cent of children with autism also have mental retardation and there is also an association with a number of medical conditions such as epilepsy, tuberous sclerosis, congenital rubella syndrome, and phenylketonuria. (20) Autism is associated with high levels of emotional and behavioural problems and burden of care. The DSM-IV and the equivalent ICD-10 diagnostic criteria for pervasive developmental disorders have assisted in providing an international consensus in diagnosis, although some diagnostic dilemmas still remain. The diagnosis of Asperger's disorder is excluded by the presence of mental retardation and delayed and deviant language development, yet there are some children with mental retardation who have non-deviant language development consistent with their developmental level who fulfil the specific social deficit and behavioural criteria for Asperger's disorder. Children with autism also frequently present with additional comorbid symptoms such as ADHD,...

Selfregulation Of Slow Cortical Potentials As A Control Strategy For Spelling Devices And Neuroprostheses

The mechanisms underlying the self-regulation of SCPs used for BCI systems has been intensively studied over the past 25 years.24,49 The self-regulation of SCPs was originally derived from animal experiments, where monkeys were positively reinforced for producing increases or decreases of slow preparatory potentials.50,51 Earlier, Fetz52 had already shown that monkeys can learn to regulate neuronal firing rates. As in animals, self-regulation of slow cortical potentials does not require continuous feedback of the neurophysiological response, but the reward of required amplitude changes in positive or negative polarity is a necessary ingredient of the learning process. Therefore, self-regulation of SCPs can be conceptualized as an implicit learning mechanism involving elements of classical and operant conditioning. It is not surprising that cognitive factors such as intelligence, motor imagery ability, age, personality characteristics, or particular imagery strategies are not critical...

Evidence for biological determinants of offending behaviour

The genetic element, if present, may be manifest in the phenotype in the constellation of hyperactivity-inattention-impulsivity attention-deficit hyperactivity disorder is a disorder of adults(25) as well as children. The genetic risk may be mediated through abnormal neuropsychological or cognitive functioning. (26) There is evidence of neuropsychological impairment in some offenders.(27)

Electrophysiological Research

EEG studies have tended to find increased slowing of cortical electrical activity in children with ADHD, although there have been conflicting findings. Increased theta (4-7 Hz) activity in ADHD subjects compared with normal controls has been found in several studies, particularly in frontal regions (Clarke et al., 1998 Mann et al., 1992 Matsuura et al., 1993 Chabot & Serfontein, 1996). Increased delta (1-3 Hz) activity, especially in posterior regions, has also been observed (Clarke et al., 1998 Matousek et al., 1984). Mann et al. (1992) found that frontal theta power was increased in children with ADHD compared to normal controls during a resting condition and increased further during cognitive tasks. As theta activity decreases with age (Gasser et al., 1988), the findings for children with ADHD resembled those of younger children, suggesting a maturational delay in children with ADHD (Mann et al., 1992). Matsuura et al. (1993) also related their findings to brain immaturity in...

Psychopharmacological treatments

Transmission, was effective in open trial.( 0) Clozapine, also very effective for self-injury but limited by its propensity for marrow toxicity, has a broad affinity for both serotoninergic and dopaminergic receptors. A stream of anecdotal reports indicate risperidone, blocking both D 2 and 5-HT2 receptor sites, to be effective in aggression, social withdrawal, and attention-deficit hyperactivity disorder. Other drugs are being evaluated unwanted weight gain will restrict the use of olanzepine, another drug with a broad receptor affinity that includes both D 2 and 5-HT2 sites. As more neuroleptics are released the clinical relevance of such subtyping remains to be confirmed. There is a widespread re-evaluation of the place of attention deficit-hyperactivity disorder, its prevalence, and management. There is a general unsubstantiated belief that it is more intractable the greater the degree of mental retardation. Methylphenidate and amphetamine remain the standard treatments, but...

Snap25 And Schizophrenia

Animal models have indicated a link between SNAP-25 and psychiatric disorders. We previously reported that levels of SNAP-25 were significantly greater in the amygdala of adult rats that were reared in isolation from weaning66. This experimental manipulation is known to induce a range of behavioral alterations, such as locomotor hyperactivity and deficits in PPI, that resemble homologous symptoms of psychotic disorders30. As isolation-reared rats also display increased anxiety, and the behavioral deficits in this paradigm have been associated with alterations in monoamine neurotransmission67, our findings may indicate a novel substrate for anxiety in this model. The behavioral deficits evident in the heterozygous Coloboma mutant mouse have been hypothesized to model various symptoms of psychiatric disorders. The hyperactivity associated with the mutant is decreased by treatment with low doses of J-amphetamine that are sufficient to induce increased activity in wild-type mice68. Thus,...

Sleeprelated Breathing Disorders Clinical Features

In schools the tiredness and sleepiness may be labeled as inattentiveness in class, daydreaming, or not being there (22,52). Concerns about school performance were raised in the original description of OSA syndrome in children (3). More recently, the possible association between SDB, learning problems, and attention-deficit disorder has been studied (8,18,19,21,22,52-56). A study by Gozal et al. examined the hypothesis that domains of neurobehavioral function would be selectively affected by SDB. They study children with reported symptoms of attention-deficit hyperactivity disorder (ADHD) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in a public school system. Children with reported symptoms of ADHD and control children were randomly selected for an overnight polysomnographic assessment and a battery of neurocognitive tests. Frequent and loud snoring was reported for 673 children (11.7 ). Similarly, 418 (7.3 ) children were reported...

Problems of children and adolescents with sensory impairment

Acquired causes of hearing impairment, such as congenital rubella, are frequently associated with other brain pathology in contrast to hereditary deafness. As for chronic physical illnesses affecting the brain, the former group of children and adolescents are at greater psychiatric risk, especially for behavioural disorders such as attention deficit disorder.(30) Children with rubella encephalopathy are at particular risk for autistic spectrum disorder. (28) Attention deficit disorder is more common in children with acquired deafness, but not in those with hereditary causes. This difference is most likely to be accounted for

Central Nervous System Stimulants

Medication is given to stimulate the central nervous system in order to induce a therapeutic response. These include medications that treat narcolepsy, attention deficit disorder (ADD), obesity, and reversal of respiratory distress. Analeptics are substances which stimulate breathing and heart activity. Methyl-phenidate (Ritalin) is an analeptic often prescribed for children with Attention Deficit Hyperactivity Disorder (ADDHD).

Neurosteroids and Personality Aggressivity and Drug Dependence

Characteristic for type A personality is also a tendency for antisocial behaviors and substance abuse. We have recently demonstrated that the low plasma levels of DHEA(S) are highly predictive of propensity to relapse in detoxified cocaine addicts (79). Lower than normal plasma levels of DHEA were also found in children and adolescents with attention deficit hyperactivity disorder (ADHD) (80), and this disorder constitutes a major risk factor for stimulant dependence (81). One can predict therefore that supplementation of some cocaine addicts with DHEA may compensate for the existing deficits of this steroid and might aid their treatment. We have initiated testing this hypothesis in a clinical trial.

The alert state required for the above

A variety of pathologies impair attention. Among these are parietal and frontal lesions (Shallice 1993), schizophrenia (Andreasen et al. 1994), and attention-deficit hyperactivity disorder, one manifestation of which is learning difficulties (Shaywitz et al. 1997). It has been suggested that attention and memory are also co-impaired in chronic fatigue syndrome, and the hypothetical 'central executive' was implicated (Joyce et al. 1996). In real-life, multiple methods could be used to enhance attention, and, good news, some of these methods are clearly devoid of any side effect a comparison of memory for humorous and non-humorous versions of sentences shows that the humorous ones are remembered better, probably because they are associated with increased attention (Schmidt 1994).

Differential diagnosis

Hyperkinetic syndrome attention-deficit hyperactivity disorder These are the names given by ICD-10 and DSM-IV respectively to very similar conditions. For convenience the term hyperactivity will be used here. The condition is characterized by impulsivity, inattention, and motor overactivity. Any of these three sets of symptoms can be misconstrued as antisocial, particularly impulsivity which is also present in conduct disorder. However, none of the symptoms of conduct disorder are a part of hyperactivity so excluding conduct disorder should not be difficult. However, a frequent error is to miss comorbid hyperactivity when conduct disorder is definitely present. So much emphasis is placed on the irritating antisocial behaviour by parents and teachers that the clinician can easily fail to enquire properly about motor restless and inattention, which can be attributed to 'naughtiness'. Standardized questionnaires are very helpful here, such as the Strengths and Difficulties...

Computerized Assessment

The principal computerized test found useful for determining nicotine effects on cognitive function in adults with ADHD is the Conners continuous performance test (CPT).5,6 To characterize possible effects on other aspects of neurobehavioral function, components of the Automated Neuropsychological Assessment Metrics (ANAM) battery have also been used simple reaction time, spatial mental rotation, and delayed matching to sample.3435 The Conners CPT has been validated as an assessment tool for diagnosing ADHD and is sensitive to stimulant therapy 5,6 it has previously been shown to be sensitive to the effects of acute nicotine treatment in adults with ADHD.726 This is a 14-minute test in which the subject is instructed to respond as quickly as possible to a target stimulus, but to refrain from responding to a more rarely occurring nontarget stimulus. This differentiates the Conners CPT from other CPTs in which the subject must respond to rarely occurring stimuli and makes it sensitive...

Psychological factors Personality

Community and clinical epidemiology findings point to the presence of other psychiatric disorders as one of the most significant psychological risk factors in alcoholism. The risk is particularly high in persons with schizophrenia, bipolar disorder, major depression, social phobia, panic disorder, post-traumatic stress, attention-deficit hyperactivity disorder, and antisocial and borderline personality disorders. (40)

Children with psychiatric disorder

Parental reports of sleep problems in children with ADHD(33) are very common, more than in other child psychiatric groups. Parental impressions can be distorted but preliminary objective evidence also suggests that persistent sleep disturbance is common and sometimes important as the primary cause (or a significant contributory factor) rather than simply a consequence of ADHD. ADHD symptoms have sometimes been attributed to definitive sleep disorders (OSA, periodic limb movements in sleep, circadian sleep rhythm disorders) in which sleep quality is impaired with improvement in ADHD symptoms following treatment of the sleep disorder. Preliminary studies of sleep physiology or other objective aspects of sleep in children have also produced evidence of sleep abnormalities. Even where ADHD is attributable to other factors, sleep disruption is likely to worsen the child's behaviour, meriting treatment in its own right wherever possible. Apart from psychiatric disorders themselves, drugs...

Periodic Limb Movement Disorder

PLMD is a sleep-related movement disorder characterized by the presence of PLMS and by clinical sleep disturbance that cannot be accounted for by another primary sleep disorder (30). The PLMS are considered responsible for sleep fragmentation and a complaint of EDS. However, PLMS are present in 6 of the general population and in more than 45 of adults aged 65 years or older (95). Also, there are a number of conditions other than RLS where PLMS are also recorded, for example, in about 45 to 60 with narcolepsy (96), 70 with RBD (97,98), 27 to 38 with OSA (95,99-101) and also in insomnia, sleep-related eating disorder (SRED), fibromyalgia, and attention deficit-hyperactivity disorder. Medications, for example, selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, and dopamine receptor antagonists are also known to precipitate PLMS. Low brain iron, as reflected by serum ferritin may also play a role. Thus, persistence of PLMS and related clinical sleep disturbance...

Manifestations of sleep disorders

The clinical features of basically the same sleep disorder can be very different in children compared with adults. The overall behavioural effects of excessive sleepiness in adults is a reduction of physical and mental activity. In contrast, its effect in young children can be increased activity with irritability, tantrums, or other behavioural difficulties. Some types of attention-deficit hyperactivity disorder ( ADHD) are thought to be the result of sleep disorders (OSA, periodic limb movements in sleep, circadian sleep-wake rhythm disorder) with improvement in the difficult behaviour following treatment of the sleep disorder. (15)

Meet the Jackoons

I have seven children, all very special, all very much loved and all very different - seven different colours of the rainbow. There are four boys and three girls the boys all being various colours of the autistic spectrum. In our house we have dyslexia, dyspraxia, Asperger Syndrome (AS), Attention Deficit, Hyperactivity Disorder (AD HD), Sensory Integration Dysfunction (SID) and autism to add that extra 'oomph' to an already manic family.


First, severe disorders like schizophrenia or attention-deficit hyperactivity disorder are accompanied by a general deficit in attentional selection. Patients display attentional deficits that are largely independent of the semantic content of the information to be processed. A good illustration is provided by the systematic work of Shakow and colleagues who sought to identify the earliest stage at which cognitive deficits occur in schizophrenics. This work revealed that schizophrenic patients perform at a normal level on repetitive motor tasks and tasks measuring visual acuity, but display a slowing of speed when they have to react to a signalled target stimulus 60 This accords well with Kraepelin' clinical observation that a general attentional dysfunction is one of the core disturbances in schizophrenia.

Dopamine Transporter

Attention deficit hyperactivity disorder (ADHD) affects between 3 and 5 of schoolage children. Treatment of major symptoms, such as inattention, hyperactivity, and impulsive behavior, has been effectively achieved using psychostimulants, of which methylphenidate (Ritalin ) is the most commonly prescribed in the United States. These drugs are beneficial in many cases however, inter-individual variation in clinical response and adverse events is well documented (55-57). Methylphenidate binds to and directly inhibits the dopamine transporter (DAT1). Accordingly, variations in genes involved in dopamine action and metabolism (such as DAT1, D2, and the D4 receptor genes) have been examined in search for explanation of the variability in clinical response to methylphenidate and other psychostimulants in ADHD patients. A recent study (58) demonstrated significant association between the 10 10 genotype in DAT1 and lack of response to methylphenidate but failed to demonstrate any association...


The solution of the general unsteady-state anisotropic diffusion equation could be important in the development of improved approaches for the analysis of DT-MRI. DT-MRI is an extension of conventional MRI with the added capability of measuring the random motion of water molecules in all three dimensions, usually referred to as diffusion or Brownian motion. As water diffusion is influenced by the microstructure, architecture, and physical properties of tissues, DT-MRI can render the information about how water diffuses in biological tissues containing a large number of fibers, like muscles or brain white matter, into intricate three-dimensional representations of the tissues architecture. Thus, it can be exploited to visualize and extract information about the brain white matter and nerve fibers by reconstructing the fiber pathways, which has raised promises for achieving a better comprehension of the fiber tract anatomy of the human brain. In combination with functional MRI, it might...


The primary aim is control of impulsivity and aggression. Medication is also used to deal with incapacitating symptoms, such as anxiety, rage, depression, and somatic complaints.(34) Selective serotonin reuptake inhibitors and lithium may be beneficial in regulating serotonergic function. Antiepileptic drugs, such as carbamazepine and clonazepam could be used for aggressive outbursts, especially if abnormal waves are noted on the EEG. Psychostimulants such as methylphenidate (Ritalin( )) may be useful if there is evidence of attention-deficit hyperactivity disorder. Benzodiazepines are contraindicated since they might cause behavioural disinhibition. Non-compliance and drug abuse are common problems therefore drugs should be used judiciously.


The positive response of children with ADHD to treatment with stimulant medications, which have dopaminergic and noradrenergic agonist activity, suggests catecholamine abnormalities in ADHD (Cantwell, 1996 Pliszka et al., 1996). As direct measurement of catecholamine concentrations in the brain is not possible, evidence for differences in ADHD has been sought from measurements of catecholamine metabolite concentrations in cerebrospinal fluid (CSF), blood and urine. The results of these studies are inconsistent (Cantwell, 1996 Mason, 1984 Pliszka et al., 1996 Raskin et al., 1984 Weizman et al., 1990), thus the precise nature of catecholamine anomalies in ADHD remains unknown and several different theories have been suggested.


The efficacy of stimulant drugs in treating ADHD suggests involvement of the dopamine system in this disorder. Methylphenidate and dexamphetamine block the reuptake of dopamine and facilitate its release from presynaptic terminals (Bradley, 1989 Malone et al., 1994 Solanto, 1998). This might suggest that dopamine may be deficient at prefrontal synapses, leading to the deficits in inhibitory control, working memory and executive functions that are common in ADHD (Pliszka et al., 1996). However, this simple hypothesis is not supported by findings that dopamine agonists such as L-dopa have proven inefficient in treating ADHD, while antidepressants, which have virtually no direct effect on the dopamine system, can be an effective treatment (Pliszka et al., 1996). There are also contradictory findings regarding the effects of dopamine antagonists, with some studies showing deleterious effects and others not (Levy, 1991). As the activity of dopamine neurons is modulated by autoreceptors and...


The best indicator of central noradrenaline levels is thought to be urinary concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG), the principal metabolite of noradrenaline. As with dopamine metabolite levels, there are conflicting findings for MHPG levels, with some studies finding reduced urinary MHPG in children with ADHD (Shekim et al., 1977, 1979, 1983, 1987), others finding increased levels (Khan & Dekirmenjian, 1981 Oades et al., 1998), and others finding no difference relative to controls (Rapoport et al., 1978). Some of the discrepancies among findings may be explained by subjects' prior use of stimulants, as urinary MHPG concentrations have been found to decrease after treatment with dexamphetamine, but not after treatment with methylphenidate (Raskin etal., 1984 Weizman et al., 1990). MHPG concentrations in plasma and in CSF have also been measured in just a few studies. Castellanos et al. (1994) found that CSF MHPG levels were positively correlated with measures of...


Given the complexity of interactions between neurotransmitters and their pharmacological effects, it seems unlikely that a simple deficiency or excess of any one neurotransmitter can account for the symptoms associated with ADHD or their improvement under drug treatment (Malone et al., 1994 Pliszka et al., 1996). Evidence suggests that dysfunctions of both noradrenergic and dopamin-ergic systems are involved, and several different theories have been suggested. One hypothesis is that noradrenergic deficits may be related to the cognitive and attentional problems associated with ADHD, while dopaminergic deficits may be related to hyperactivity (Mason, 1984). Another suggests that the central nora-drenaline system may be dysregulated in ADHD, leading to inefficient priming of the posterior attention system to external stimuli, while effective mental processing is affected by deficient dopaminergic function in the executive anterior attention system (Pliszka et al., 1996). Malone et al....

Molecular Genetics

Long standing evidence from family, twin and adoption studies suggests that ADHD is heritable and that genetics play a major role in the aetiology of this disorder (Levy et al., 1997 Tannock, 1998 Thapar et al., 1999). Evidence from pharmacological and brain imaging studies for dopamine system abnormalities in ADHD has focussed recent molecular genetic research on dopaminergic genes. Polymorphisms defined by variable numbers of tandem repeats of two genes in particular have now been found to be associated with ADHD in multiple studies, although conflicting findings have also occurred. Because drugs that inhibit the dopamine transporter (including methyl-phenidate, dexamphetamine and pemoline) are effective in treating ADHD, the dopamine transporter (DAT1) gene has been examined as a potential candidate gene for ADHD. Studies involving children with ADHD and their parents have found a significant association between a 10-repeat allele of the DAT1 gene and ADHD (Cooketal., 1995 Daly...

Studies of Attention

Attention has been a major focus of neuropsychological research into ADHD and deficits on various tasks designed to measure attentional aspects of performance have been found in children with ADHD. However, task performance in these children has been found to be affected by many factors other than attention and it is generally concluded that poor performance cannot be attributed to a specific deficit in attention (Barkley, 1997 Schachar, 1991 Swanson et al., 1990 Van der Meere, 1996). Instead, the cognitive deficit in ADHD appears to be at the output or motor stage of information processing rather than at input or attentional stages (Barkley, 1997 Van der Meere, 1996). In a series of studies that manipulated task parameters in order to isolate different aspects of information processing Van der Meere, Sergeant and colleagues found no evidence of specific deficits in selective, focussed, sustained or divided attention, encoding, search or decision processes, or acquisition of automatic...

Clinical Assessment

The positive diagnosis of ADHD was made by an experienced clinical psychologist using standard criteria for ADHD in adults as described in the DSM-IV manual.10 Other useful measures for characterizing the presence of adult ADHD are the Wender Utah rating scale,46 the Conners Wells adolescent and adult self-report (CASS),8 and the Barkley's adult ADHD semi-structured interview.2 The benchmark clinical outcome measure of ADHD symptoms is the clinical global impression (CGI) scale, which is scored through a structured interview by a trained clinician. In research studies it is essential that the interviewing clinician be blind to treatment condition. The CGI is a standard seven-point scale widely used in clinical studies in which higher scores indicate more severe clinical states.28 On the CGI scale are 1 normal, 2 borderline, 3 mildly ill, 4 moderately ill, 5 markedly ill, 6 severely ill, and 7 extremely ill. It was found that the CGI was significantly reduced by acute nicotine...

Structural Imaging

Early studies which utilized Computerized Tomography (CT) to image brain structure in children and adults with ADHD revealed few significant differences from controls. In a comparison between children with ADHD and a control group who required CT scans for various clinical indications, no group differences were found in lateral ventricular size or in frontal lobe width, but the frontal lobes were found to be more symmetric in the ADHD group (Shaywitz et al., 1983). These authors concluded that if anatomic abnormalities exist in ADHD, they were not distinguishable using CT techniques available at that time. In a study of young adult males, no group differences were found in ventricular or hemispheric areas between an ADHD group and a group who required CT scans for evaluation of head trauma (Nasrallah et al., 1986). This study did find a 58 prevalence of mild to moderate cortical atrophy in the ADHD group, but the authors concluded that this finding may be due as much to coexisting...

Functional Imaging

Positron Emission Tomography (PET) studies of ADHD have mostly been restricted to older subjects due to concerns about exposing children to the radioactive isotopes necessary for this technique (Lou, 1992 Zametkin et al., 1990, 1993). The few studies that have been conducted have yielded inconsistent results. Zametkin et al. (1990) found reduced global glucose metabolism and reduced regional metabolism in 30 of the 60 areas examined in adults with a history of childhood ADHD, when compared with normal controls. The greatest decreases in metabolism occurred in premotor and superior prefrontal cortex, areas associated with control of motor activity and attention, suggesting a relationship between reduced frontal metabolic activity and ADHD symptoms (Zametkin et al., 1990). Reduced metabolism in ADHD subjects was also found in the striatum and the thalamus. In a subsequent study of adolescents with ADHD (Zametkin et al., 1993), no significant group differences were found for global or...

Clinical Disorders

A third classification of disorders related to nicotinic function is those where there is no known loss or genetic alteration of nicotinic receptors, but there is evidence that stimulating nicotinic receptors may have therapeutic value. These disorders include ADHD, anxiety and depression, and Tourette's syndrome. Attention deficit hyperactivity disorder (ADHD) is a clinical syndrome usually diagnosed in childhood. While to date no firm evidence of nicotinic system dysfunction in this disorder exists, current pharmacological treatments are psychostimulants, which are presumably effective via their interactions with dopamine. The primary deficits of this disorder involving attention are affected by nicotine administration in other clinical populations.25 Pilot studies administering nicotine to patients with ADHD have shown improvements in clinical global impressions (CGI) of symptoms, and on attentional tasks.26

Methyl Effects

Figure 3. (A) Topography of reference task - CPT-AX differences for ADHD and control groups at the disappearance of the cue A. For SSVEP amplitude (normalized units) and latency (ms), warmer colours (pink red) indicate reductions at this time in the CPT-AX relative to the reference task, cooler colours (blue) indicate increases. Hotelling's T maps indicate the statistical strength of these differences, warmer colours indicate higher T values. Iso-T contours represent uncorrected p values of 0.01 and 0.001. (B) Topography of pre-methylphenidate CPT-AX - post-methylphenidate CPT-AX differences for ADHD boys at the disappearance of the cue A. For SSVEP amplitude (normalized units) and latency (ms), warmer colours (pink red) indicate reductions at this time post-methylphenidate relative to pre-methylphenidate, cooler colours (blue) indicate increases. Hotelling's T maps indicate the statistical strength of these differences, warmer colours indicate higher T values. Iso-T contours...


Tasks that measure sustained or continuous attention performance appear to show the most robust nicotinic effects. Tasks such as the rapid visual information processing task or the Connor's continuous performance test have shown sensitivity to nicotinic stimulation in normal volunteers,60,61 patients with ADHD, and patients with Alzheimer's disease.6263 Measures of selective attention have produced more mixed results. For example, the Stroop task is a measure of conflict between verbal and color processing. While some studies have demonstrated a reduction in the Stroop effect with cigarettes or nicotinic stimulation64 others have shown inconsistent results60 or results suggesting that nicotine enhances the Stroop effect.23 Measures which examine attentional performance over very long periods of time have shown positive effects of nicotine,65 especially in preventing performance decrements. Nic-otinic stimulation has been shone to improve attentional performance in primates,...


Alcohol, drugs, including some prescription drugs, cigarettes, and excessive caffeine (more than 2 to 3 cups coffee) should be avoided to minimize the risk of conditions such as low birth weight, sudden-death syndrome, retarded growth, hyperactivity, attention deficit disorder, and emotional problems of the child. It is important to get sufficient rest, sleep, nonjarring exercise, and to reduce stress. Exercises that strengthen the abdominal muscles ease pain in the lower back.

Multicoloured Mayhem

Reweaving the Autistic Tapestry Autism, Asperger Syndrome and ADHD Lisa Blakemore-Brown ISBN 1 85302 748 0 1. Autistic children--Care. 2. Autistic children--Family relationships. 3. Asperger's syndrome--Patients--Family relationships. 4. Attention-deficit hyperactivity disorder--Patients--Care. 5. Developmentally disabled children--Care. 6. Parents of autistic children. 7. Parenting. I. Title. RJ506.A9J325 2004 649'.154--dc22

Drug withdrawal

Spencer, T., Biederman, J., Steingard, T., et al. (1993). Bupropion exacerbates tics in children with attention-deficit hyperactivity disorder and Tourette's syndrome. Journal of the American Academy of Child and Adolescence Psychiatry, 32, 211-14. 53. Wender, P.H. and Reimherr, F.W. (1990). Bupropion treatment of attention-deficit hyperactivity disorder in adults. American Journal of Psychiatry, 147, 1018-20.

Opsoclonus Myoclonus

With progressive neurological deterioration, inability to sit or stand, slurred speech rage attacks, hypotonia, head tilt, Horner's syndrome, deep tendon reflex abnormalities, or seizures. The chronic phase is associated with variable impaired cognitive function, IQ loss (Papero et al. 1995), attention deficit disorder with or without hyperactivity, obsessive compulsive disorder, mood and conduct disorders (Koh et al. 1994), speech articulation and fluency problems, ataxia (Mitchell et al. 2002), ocular flutter, and strabismus. Children with moderate and severe symptoms at the onset of OMS will not improve on their own and require immunotherapy. The wait and watch approach in this group following tumor resection is ill-advised (Blaes 2002).

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