Attention deficit hyperactivity disorder (ADHD) is a condition where children under the age of 12 years old have hyperactive behaviour and problems paying attention that have a significant impact in more than one setting (for example, home and school).

Aetiology

• ADHD is associated with reduced activity in the frontal lobe, resulting in problems with executive function. This impairs the ability to focus on different tasks and inhibit impulsive behaviours.

Features

All the features of ADHD can be part of a normal spectrum of childhood behaviour. When many of these features are present and it is adversely affecting the child, ADHD can be considered:

• Very short attention span
• Quickly moving from one activity to another
• Quickly losing interest in a task and not being able to persist with challenging tasks
• Constantly moving or fidgeting
• Impulsive behaviour
• Disruptive or rule breaking

Management

Conservative:

• Behavioural techniques
• Extra support at school. However, ADHD does not generally affect intellectual ability.

Medical:

• Stimulant medication such as methylphenidate. These medicines have some activity in the frontal lobe thus increasing executive function, attention, and reducing impulsivity.
  • NOTE - important side effects of methylphenidate - appetite suppression and subsequent growth suppression - may also be associated with weight loss, also facial tics
• ADHD refractory to methylphenidate or in those who experience side effects - Atomexetine

Prognosis