Attentiondeficit hyperkinetic disorders in childhood and adolescence

Russell Schachar and Abel Ickowicz Introduction

History

Evolutionpf theconcept

EvolutionM" nomenclature EvolutionM" clinicaLpractice

ClinicaLfeatures

Classification

Impairment

Comorbidity

Subtypes

Diagnosis and differential diagnosis Assessment, ofchNdren

Assessment, „ofadolescents „andadujts

Epidemiology Aetiology

CoqnitiveMalndMnneura!MbasiSMpf, AD.-H.KP

Neurobiologicail.and,, psychp,spcian!,riMs,k„ .factors

GeneticM.factors

Course MandMpro.gnosis Treatment

Prevalence pf.med,icatipn., „use

Neurobiology ..of. themedications .used.. to Mt.re.at.A.D-HKD

Pharmacology ..of stimulant.. medication

Therapeuticeffects, .of.stim.u.lants

Variation among, .stimulants Limitations .0lfstimu!antMmedicatipn Non-stimulant. medications Behaviourall . treatment

Multimodail., treatment

Management General principles

InitiatingMtreatment.. withMm.edic.ation lM1on,Mt,o,rinfl„,s¡,de,-sffs,cis

Prevention

Conclusions

Chapter., References Introduction

The syndrome of restless, inattentive, and impulsive child behaviour known as attention-deficit hyperactivity disorder ( ADHD) in North America and hyperkinetic disorder (HD) in Europe is a common mental health problem. This disorder is a source of considerable adversity for those affected and their families. Persons affected by this disorder in childhood are at risk for learning, behavioural, and social problems and also for the development of serious impairments such as academic failure, substance abuse, and criminality in adolescence and adulthood. Consequently, the disorder places a substantial demand on mental health, educational, and judicial services.

This disorder reflects the interplay of biological, psychological, and social factors. Biological factors such as genetic risk are clearly implicated in the neuropathology of ADHD and HD. However, social influences are significant determinants of the impairment associated with the disorder, the prognosis for individual children, and attitudes toward the cause of the disorder and its therapy. Psychological processes, particularly deficits in attention and information-processing, mediate the link between the underlying neuropathology and the behavioural manifestations of the disorder. Consequently, the disorder is informative for the study of child psychopathology in general.

Important differences exist between the diagnostic traditions of North America and Europe. We examine them specifically in this chapter, along with the characteristics they share (signalled by our use of the term 'AD-HKD'). The purpose of this chapter is to review our current understanding of the causes, natural history, and treatment of AD-HKD in the context of its social and historical development.

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